Diagnosis of clostridium difficile infection

An ongoing conundrum for clinicians and for clinical laboratories

Carey Ann D Burnham, Karen C Carroll

Research output: Contribution to journalArticle

Abstract

Clostridium difficile is a formidable nosocomial and communityacquired pathogen, causing clinical presentations ranging from asymptomatic colonization to self-limiting diarrhea to toxic megacolon and fulminant colitis. Since the early 2000s, the incidence of C. difficile disease has increased dramatically, and this is thought to be due to the emergence of new strain types. For many years, the mainstay of C. difficile disease diagnosis was enzyme immunoassays for detection of the C. difficile toxin(s), although it is now generally accepted that these assays lack sensitivity. A number of molecular assays are commercially available for the detection of C. difficile. This review covers the history and biology of C. difficile and provides an in-depth discussion of the laboratory methods used for the diagnosis of C. difficile infection (CDI). In addition, strain typing methods for C. difficile and the evolving epidemiology of colonization and infection with this organism are discussed. Finally, considerations for diagnosing C. difficile disease in special patient populations, such as children, oncology patients, transplant patients, and patients with inflammatory bowel disease, are described. As detection of C. difficile in clinical specimens does not always equate with disease, the diagnosis of C. difficile infection continues to be a challenge for both laboratories and clinicians.

Original languageEnglish (US)
Pages (from-to)604-630
Number of pages27
JournalClinical Microbiology Reviews
Volume26
Issue number3
DOIs
StatePublished - Jul 2013

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Clostridium Infections
Clostridium difficile
Toxic Megacolon
Colitis
Immunoenzyme Techniques
Inflammatory Bowel Diseases
Diarrhea
Epidemiology
History

ASJC Scopus subject areas

  • Immunology and Microbiology(all)
  • Epidemiology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases
  • Microbiology (medical)

Cite this

Diagnosis of clostridium difficile infection : An ongoing conundrum for clinicians and for clinical laboratories. / Burnham, Carey Ann D; Carroll, Karen C.

In: Clinical Microbiology Reviews, Vol. 26, No. 3, 07.2013, p. 604-630.

Research output: Contribution to journalArticle

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