Usefulness of Immunological Detection of Both Toxin A and Toxin B in Stool Samples for Rapid Diagnosis of <I>Clostridium difficile</I>-associated Diarrhea

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  • TOYOKAWA Masahiro
    Laboratory for Clinical Investigation, Osaka University Hospital
  • UEDA Akiko
    Laboratory for Clinical Investigation, Osaka University Hospital
  • NISHI Isao
    Laboratory for Clinical Investigation, Osaka University Hospital
  • ASARI Seishi
    Department of Infection and Prevention, Osaka University Hospital
  • ADACHI Keiko
    Laboratory Medicine, Tokyo Metropolitan Geriatric Hospital
  • ANNAKA Megumi
    Laboratory Medicine, Tokyo Metropolitan Geriatric Hospital
  • INAMATSU Takashi
    Department of Infection Disease, Tokyo Metropolitan Geriatric Hospital

Bibliographic Information

Other Title
  • <I>Clostridium difficile</I>関連下痢症の迅速診断における糞便中toxin Aおよびtoxin B同時検出キットの有用性に関する検討
  • Clostridium difficile関連下痢症の迅速診断における糞便中toxin Aおよびtoxin B同時検出キットの有用性に関する検討
  • Clostridium difficile カンレン ゲリショウ ノ ジンソク シンダン ニ オケル フンベン チュウ toxin A オヨビ toxin B ドウジ ケンシュツ キット ノ ユウヨウセイ ニ カンスル ケントウ
  • Usefulness of Immunological Detection of Both Toxin A and Toxin B in Stool Samples for Rapid Diagnosis of Clostridium difficile-associated Diarrhea

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Abstract

Toxin detection from stool specimens is critical for the diagnosis of Clostridium difficile-associated diarrhea (CDAD). In Japan, only two toxin detection kits targeting toxin A alone are commercially available. We evaluated ImmunoCard Toxin A & B (ImmunoCard), based on enzyme immunoassay for the rapid detection of both C. difficile toxins A and B in stool specimens, compared to a toxin A detection kit (Uniquick) and cytotoxin assay. C. difficile was also cultured from stool specimens and the toxin production type of C. difficile isolates was identified by PCR analysis. Compared to cytotoxin assay, ImmunoCard sensitivity was 86.2%, specificity 93.8%, positive predictive value 91.8%, and negative predictive value 89.4% (n=146). Sensitivity was significantly higher than that of Uniquick (60.0%, p=0.0016). ImmunoCard detected 90.6% of cytotoxin positive specimens with isolated toxin A-positive, toxin B-positive C. difficile strains (Uniquick; 67.9%, p=0.008) and 70.0% of these with isolated toxin A-negative, toxin B-positive C. difficile strains. Although ImmunoCard was slightly less sensitive than cytotoxin assay, it requires no special equipment and completes the entire test in up to 20min. ImmunoCard thus appears very useful in the rapid diagnosis of CDAD in the clinical laboratory. Kits for the detection of both C. difficile toxins A and B should be immediately introduced into Japan to ensure the correct diagnosis of CDAD and infection control.

Journal

  • Kansenshogaku Zasshi

    Kansenshogaku Zasshi 81 (1), 33-38, 2007

    The Japanese Association for Infectious Diseases

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