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Line 6:
Line 6: − + − -Diagnostic criteria+ − --Diarrhea+ − -Positive stool test for toxigenic C. diff or toxins or pseudomembranous colitis+ − -Diagnostic approaches+ − -Toxigenic Culture (TC) and/or Cell Cytotoxicity Assay (CCA)+ − ---Anaerobic culture for 24-48 hrs followed by colony selection and culture with+ − -Gold standard+ − --- Time consuming and difficult, up to 5 days+ − ---Detects a little as 3 picograms of toxin+ − -Stool antigen looks for Glutamate dehydrogenase (COH) via ELISA (SIA)+ − ---Does not distinguish between toxigenic and non-toxigenic strains+ − ---Half of C. diff isolates are non-toxigenic+ − --PCR / NAAT+ − --Detects tcdA/tcdB genes, mRNA for the toxins+ − ---Detects presence of toxigenic strains of C. diff+ − -mRNA doesn't necessarily imply active infection+ − --EIA / ELISA+ − ---Detects toxin in stool+ − ---LOw sensitivity (0.73-0.87)+ − -Multistep algorithms, there are dozens+ − --EIA for GDH / Toxin A/B+ − --Both positive = C. diff+ − -Both negative = NO C. diff+ − --Mixed results, use PCR for tedB as tiebreaker+ − -Toxin EIA 1 (Meridian), higher PPV, lower NPV+ − --Toxin EIA 2 (TechLab), lower PPV, higher NPV+ − -Highest NPV (99.8%) GDH EIA + NAAT+ − ---Highest PPV (93.5%) Toxin EIA 1 + NAAT+ +
→DIAGNOSIS
==DIAGNOSIS==
==DIAGNOSIS==
Laboratory testing cannot distinguish between asymptomatic colonization and
* Laboratory testing cannot distinguish between asymptomatic colonization and
¿Eyed frat' cuitisten a forfindsfficile. The best test performance characteristics
¿Eyed frat' cuitisten a forfindsfficile. The best test performance characteristics
===Diagnostic criteria===
* Diarrhea
* Positive stool test for toxigenic C. diff or toxins or pseudomembranous colitis
===Diagnostic approaches===
* Toxigenic Culture (TC) and/or Cell Cytotoxicity Assay (CCA)
** Anaerobic culture for 24-48 hrs followed by colony selection and culture with
human cells to test for cell cytotoxicity which takes an additional 24-48 hours.
human cells to test for cell cytotoxicity which takes an additional 24-48 hours.
* Gold standard
** Time consuming and difficult, up to 5 days
** Detects a little as 3 picograms of toxin
* Stool antigen looks for Glutamate dehydrogenase (COH) via ELISA (SIA)
** Does not distinguish between toxigenic and non-toxigenic strains
** Half of C. diff isolates are non-toxigenic
* PCR / NAAT
** Detects tcdA/tcdB genes, mRNA for the toxins
*** Detects presence of toxigenic strains of C. diff
* mRNA doesn't necessarily imply active infection
** EIA / ELISA
*** Detects toxin in stool
*** Low sensitivity (0.73-0.87)
* Multistep algorithms, there are dozens
** EIA for GDH / Toxin A/B
* Both positive = C. diff
* Both negative = NO C. diff
* Mixed results, use PCR for tedB as tiebreaker
** Toxin EIA 1 (Meridian), higher PPV, lower NPV
** Toxin EIA 2 (TechLab), lower PPV, higher NPV
* Highest NPV (99.8%) GDH EIA + NAAT
* Highest PPV (93.5%) Toxin EIA 1 + NAAT
==TREATMENT==
==TREATMENT==
-First line treatment
-First line treatment