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- Title
Comparison of Clostridioides difficile Stool Toxin Concentrations in Adults With Symptomatic Infection and Asymptomatic Carriage Using an Ultrasensitive Quantitative Immunoassay.
- Authors
Pollock, Nira R; Banz, Alice; Chen, Xinhua; Williams, David; Xu, Hua; Cuddemi, Christine A; Cui, Alice X; Perrotta, Matthew; Alhassan, Eaman; Riou, Brigitte; Lantz, Aude; Miller, Mark A; Kelly, Ciaran P
- Abstract
Background We used an ultrasensitive, quantitative single molecule array (Simoa) immunoassay to test whether concentrations of Clostridioides (formerly Clostridium) difficile toxins A and/or B in the stool of adult inpatients with C. difficile infection (CDI) were higher than in asymptomatic carriers of toxinogenic C. difficile. Methods Patients enrolled as CDI-NAAT had clinically significant diarrhea and a positive nucleic acid amplification test (NAAT), per US guidelines, and received CDI treatment. Potential carriers had recently received antibiotics and did not have diarrhea; positive NAAT confirmed carriage. Baseline stool samples were tested by Simoa for toxin A and B. Results Stool toxin concentrations in both CDI-NAAT (n = 122) and carrier-NAAT (n = 44) cohorts spanned 5 logs (0 pg/mL to >100000 pg/mL). Seventy-nine of 122 (65%) CDI-NAAT and 34 of 44 (77%) carrier-NAAT had toxin A + B concentration ≥20 pg/mL (clinical cutoff). Median toxin A, toxin B, toxin A + B, and NAAT cycle threshold (Ct) values in CDI-NAAT and carrier-NAAT cohorts were similar (toxin A, 50.6 vs 60.0 pg/mL, P =.958; toxin B, 89.5 vs 42.3 pg/mL, P =.788; toxin A + B, 197.2 vs 137.3 pg/mL, P =.766; Ct, 28.1 vs 28.6, P =.354). However, when CDI/carrier cohorts were limited to those with detectable toxin, respective medians were significantly different (A: 874.0 vs 129.7, P =.021; B: 1317.0 vs 81.7, P =.003, A + B, 4180.7 vs 349.6, P =.004; Ct, 25.8 vs 27.7, P =.015). Conclusions Toxin concentration did not differentiate an individual with CDI from one with asymptomatic carriage. Median stool toxin concentrations in groups with CDI vs carriage differed, but only when groups were defined by detectable stool toxin (vs positive NAAT).
- Subjects
CLOSTRIDIUM diseases; FECAL analysis; BACTERIAL toxins; COMPARATIVE studies; DIARRHEA; IMMUNOASSAY; MEDICAL protocols; SYMPTOMS; NUCLEIC acid amplification techniques; DIAGNOSIS
- Publication
Clinical Infectious Diseases, 2019, Vol 68, Issue 1, p78
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciy415