Clostridioides difficile Toxins A and B, EIA

Stool

5 g

0.5 g or 0.5 mL liquid stool

Sterile screw-cap container or stool transport (Para-Pak® white clean vial), no preservative. “Cool Whip” containers, denture cups, or other similar containers often leak or even explode during transport and may be rejected by the laboratory.

Aid in the diagnosis of antibiotic-associated diarrheal disease and pseudomembranous colitis

Detection of toxins A and B by enzyme immunoassay has a sensitivity approaching 90%, so multiple specimens may need to be tested. Performance characteristics have not been established in a pediatric population.

Enzyme immunoassay (EIA) for Clostridium difficile toxins A and B

C difficile can produce two toxins, designated A and B, that have pathogenic effects in humans. Antibiotic-associated pseudomembranous colitis has been shown to result from the action of these two toxins. This disease has been associated with clindamycin use but it is now recognized that pseudomembranous colitis can follow administration of virtually any antibiotic. More than 70% of the cases in a large series were associated with cephalosporin therapy.¹ The clinical spectrum of antibiotic-induced syndromes caused by C difficile includes patients with symptoms of acute abdomen with little or no diarrhea, as well as cases with fulminant life-threatening diarrhea. Nosocomial transmission and reinfection with different strains occurs as do spontaneous cases without prior antimicrobial therapy. In cases where cessation of antibiotic therapy does not produce a response, specific therapy with oral vancomycin, metronidazole, or oral bacitracin may be effective. Detection of the toxins produced by C difficile (rather than culture of the organism) is important in the determining therapy of this potentially fatal disease. The routine use of culture does not seem appropriate because of the costs and the high rate of recovery of strains which do not produce toxin.