Somily Ali Mohammed, Khan Mohammad Aatif, Morshed Muhammad
Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia.
Microbiology Laboratory, Prince Mohammad Bin Abdul Aziz Hospital, Riyadh, Saudi Arabia.
J Infect Dev Ctries. 2021 Oct 31;15(10):1364-1375. doi: 10.3855/jidc.13217.
Clostridioides difficile can cause colitis and is associated with hospital acquired infections. The C. difficile infection (CDI) is due to production of toxins A and B which bind to epithelial cell surface receptors and triggers signaling pathways, leading to loss of epithelial barrier function, apoptosis, and inflammation, culminating in diarrheal disease. In early days, laboratory diagnosis of CDI was based on cell culture, identification of toxins, and their cytopathic effects. These assays were replaced by enzyme immunoassays for the detection of C. difficile toxins and the GDH house-keeping gene for improved specificity. Later, molecular assays with higher sensitivity were introduced which are becoming easier to incorporate into the test algorithm. The diagnosis of CDI and significance of laboratory results can be challenging with asymptomatic colonization of C. difficile in some patients. Test result interpretation is even more challenging due to multiple guidelines, emerging resistant C. difficile ribotypes, as well as differences in disease prevalence. An accurate test result for diagnosis of CDI depends on selecting patients with high pre-test probability, collecting an acceptable stool specimen, and a thorough understanding of current test methods.
艰难梭菌可导致结肠炎，并与医院获得性感染相关。艰难梭菌感染（CDI）是由于产生毒素A和B，它们与上皮细胞表面受体结合并触发信号通路，导致上皮屏障功能丧失、细胞凋亡和炎症，最终导致腹泻病。早期，CDI的实验室诊断基于细胞培养、毒素鉴定及其细胞病变效应。这些检测方法被酶免疫测定法所取代，用于检测艰难梭菌毒素和GDH管家基因，以提高特异性。后来，引入了灵敏度更高的分子检测方法，这些方法越来越容易纳入检测算法。对于一些无症状艰难梭菌定植的患者，CDI的诊断和实验室结果的意义可能具有挑战性。由于多种指南、新出现的耐药艰难梭菌核糖体分型以及疾病患病率的差异，检测结果的解释更具挑战性。CDI诊断的准确检测结果取决于选择预测试概率高的患者、采集可接受的粪便标本以及对当前检测方法的透彻理解。
