Biddle W L, Harms J L, Greenberger N J, Miner P B
Division of Gastroenterology, University of Kansas Medical Center, Kansas City.
Am J Gastroenterol. 1989 Apr;84(4):379-82.
Diagnosis of Clostridium difficile (C. difficile) by its antigen or toxin has improved treatment for patients who have antibiotic-associated diarrhea and opportunistic colonization of the colon with C. difficile. Unfortunately, results from the tissue culture cytotoxicity assay are not available for 48 h. We prospectively compared a latex agglutination test with the tissue culture cytotoxicity assay in 83 patients (15 with antibiotic-associated diarrhea, 23 with non-antibiotic-associated diarrhea, and 45 without diarrhea). In the antibiotic-associated diarrhea group, 43% of patients with pseudomembranes and 25% without pseudomembranes tested positive with both tests. In the non-antibiotic groups 92% with diarrhea and 90% without diarrhea were negative with both tests. The number of discordant results illustrates the value of using two tests to identify C. difficile, since additional patients can be identified by using two tests. We found false positives were rare, and C. difficile toxin or antigen could not be detected in more than half the patients with pseudomembranes. The latex agglutination test for C. difficile is reliable, specific, and faster than the tissue culture cytotoxicity assay. The data suggest that other organisms may also be responsible for pseudomembranous colitis, and that negative tests do not obviate the need for visual evaluation of colonic mucosa in suspected cases of antibiotic-associated diarrhea.
通过检测艰难梭菌（C. difficile）的抗原或毒素来诊断该菌，已改善了对患有抗生素相关性腹泻以及结肠被艰难梭菌机会性定植患者的治疗。遗憾的是，组织培养细胞毒性试验的结果要48小时后才能得出。我们前瞻性地比较了83例患者（15例患有抗生素相关性腹泻，23例患有非抗生素相关性腹泻，45例无腹泻）的乳胶凝集试验和组织培养细胞毒性试验。在抗生素相关性腹泻组中，有假膜的患者中43%以及无假膜的患者中25%两种检测均呈阳性。在非抗生素组中，有腹泻的患者中92%以及无腹泻的患者中90%两种检测均为阴性。结果不一致的数量说明了使用两种检测来鉴定艰难梭菌的价值，因为使用两种检测可识别出更多患者。我们发现假阳性很少见，并且超过一半有假膜的患者检测不到艰难梭菌毒素或抗原。艰难梭菌乳胶凝集试验可靠、特异，且比组织培养细胞毒性试验更快。数据表明，其他微生物也可能导致假膜性结肠炎，并且阴性检测结果并不能排除在疑似抗生素相关性腹泻病例中对结肠黏膜进行肉眼评估的必要性。
