{"id":2071,"date":"2022-08-04T16:39:11","date_gmt":"2022-08-04T04:39:11","guid":{"rendered":"https:\/\/www.awanuilabs.co.nz\/south\/otagosouthland\/?page_id=2071"},"modified":"2022-08-04T16:39:12","modified_gmt":"2022-08-04T04:39:12","slug":"clostridioides-difficile","status":"publish","type":"page","link":"https:\/\/www.awanuilabs.co.nz\/south\/otagosouthland\/referrers\/microbiology-resources\/how-do-i-diagnose\/clostridioides-difficile\/","title":{"rendered":"Clostridioides difficile"},"content":{"rendered":"\n<p><strong>Infection:<\/strong> <em>Clostridioides<\/em> <em>difficile <\/em>(previously <em>Clostridium<\/em> <em>difficile<\/em>) infection ; <em>C. diff<\/em>; <em>C. difficile<\/em> diarrhoea<\/p>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\"><strong>Brief description:<\/strong><\/summary><div class=\"ab-accordion-text\">\n<ul id=\"block-a793c948-2a6b-4d4d-af27-af1950f1cfd3\"><li>Is a bacteria that causes disease by producing a toxin in the bowel.<\/li><li>Causes diarrhoea, particularly in people who have recently received antibiotic treatment.<\/li><li>Other risk factors include advanced age, hospitalisation and comorbid illnesses.<\/li><\/ul>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\"><strong>Did you know?<\/strong><\/summary><div class=\"ab-accordion-text\">\n<p>A small proportion of people carry <em>C. difficile<\/em> in their bowel under normal circumstances. This proportion goes up in people who have been hospitalised and in young children.<\/p>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\"><strong>Who do I test?<\/strong><\/summary><div class=\"ab-accordion-text\">\n<p>Test people with unexplained (e.g. not just due to laxatives, enteral feeding) diarrhoea that <strong>occurs in hospital<\/strong>, or in other people who have <strong>risk factors and persistent diarrhoea<\/strong>.<\/p>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\"><strong>Test of choice:<\/strong><\/summary><div class=\"ab-accordion-text\">\n<p>Request <a href=\"https:\/\/scg.aphg.co.nz\/#!\/WEL\/details\/FCD\"><em>C. diff<\/em> stool testing<\/a> (must be liquid\/take shape of the container)<\/p>\n\n\n\n<ul id=\"block-908e8741-5666-4fe4-8d7c-7f0cc57d1d9f\"><li>Many laboratories use a <strong>two-step protocol<\/strong><\/li><li>Step 1: test for presence of organism in the stool: <strong>GDH antigen or PCR\/NAAT<\/strong><ul><li>Good <strong>sensitivity&nbsp;<\/strong>&#8211; a <strong>negative <\/strong>test makes the diagnosis <strong>unlikely<\/strong><\/li><li>Reasonable <strong>specificity&nbsp;<\/strong>&#8211; a <strong>positive <\/strong>test confirms <strong>presence of the organism<\/strong>, but does not necessarily imply <strong>toxin production\/disease<\/strong><\/li><\/ul><\/li><li>Step 2: test for presence of toxin in the stool: <strong>toxin enzyme immunoassay (EIA)<\/strong><ul><li>Reasonable <strong>sensitivity&nbsp;<\/strong>&#8211; a <strong>negative <\/strong>test makes the diagnosis <strong>less likely<\/strong>, but cannot exclude it.<\/li><li>Good <strong>specificity <\/strong>&#8211; a <strong>positive <\/strong>test makes the diagnosis <strong>likely <\/strong>in the appropriate clinical context<\/li><li>To <strong>enhance the sensitivity<\/strong> of toxin detection, our laboratory performs <strong>toxigenic culture<\/strong> on stools that test <strong>positive for GDH antige<\/strong>n, but <strong>negative for toxin EIA<\/strong>.<ul><li>Stools are <strong>cultured <\/strong>for 48h to grow <em>C.diff<\/em>. The cultures are then <strong>tested directly with a toxin EIA<\/strong> to detect toxin production.<\/li><\/ul><\/li><\/ul><\/li><li>Note, most <strong>PCR\/NAAT<\/strong> tests detect the <strong>specific gene that produces toxin<\/strong>. This tells you that the organism is <strong>capable <\/strong>of producing the toxin, but does not necessarily tell you it has <strong>switched on toxin production<\/strong> (which is what causes disease).<ul><li>Some labs use PCR\/NAAT as a <strong>standalone test,<\/strong> however we favour a separate test to look for toxin in stool, which <strong>increases the overall specificity<\/strong> of the testing process.<\/li><\/ul><\/li><\/ul>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\"><strong>Tests to avoid\/specialist tests:<\/strong><\/summary><div class=\"ab-accordion-text\">\n<ul id=\"block-ec820be8-3119-4ba1-a249-4c8da46bfd29\"><li>Test of cure:<ul><li>This is not recommended, as many patients will <strong>remain positive<\/strong> on testing, even with successful treatment. <strong>Resolution of diarrhoea <\/strong>is the goal of treatment.<\/li><\/ul><\/li><li>Testing in young children:<ul><li>This should only be done under specialist guidance, as children l<strong>ess than 3 years of age <\/strong>will often have a <strong>positive test<\/strong>, even if <em>C.diff<\/em> is not the cause of their symptoms.<\/li><\/ul><\/li><\/ul>\n<\/div><\/details><\/div>\n","protected":false},"excerpt":{"rendered":"Infection: Clostridioides difficile (previously Clostridium difficile) infection ; C. diff; C. difficile diarrhoea","protected":false},"author":18,"featured_media":0,"parent":2060,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-left-sidebar.php","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Clostridioides difficile &#8212; Awanui Labs \u2013 Otago, Southland<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.awanuilabs.co.nz\/south\/otagosouthland\/referrers\/microbiology-resources\/how-do-i-diagnose\/clostridioides-difficile\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Clostridioides difficile &#8212; Awanui Labs \u2013 Otago, Southland\" \/>\n<meta property=\"og:description\" content=\"Infection: Clostridioides difficile (previously Clostridium difficile) infection ; 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