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Clostridium difficile: A Neglected, but Emerging Pathogen in India

Background: C. difficile (CD) is a common pathogen causing antibiotic-associated diarrhea in the US and Europe, but is a neglected enteric pathogen in India. During the last decade this organism has become the leading enteric pathogen causing antibiotic-associated diarrhea in Nosocomial and community populations. Laboratory confirmation is the only method of detecting C. difficile. Different laboratory test methods include enzyme immunoassays (EIAs), lateral flow tests, PCR assays, tissue culture cytotoxicity neutralization tests and toxigenic culture. Sensitivity, specificity, turnaround time and cost effectiveness of these tests differs grossly. The Tech lab C. difficile quik chek complete kit (USA) is the only commercial diagnostic lateral flow rapid kit detecting Glutamate deHydrogenase (GDH) and CD toxin simultaneously in a single test cassette. Comparative analysis of Techlab kit with cytotoxicity assay showed 88% predictive rate. The test is easy, rapid and has good specificity. Tech lab kit can be used for screening and any discrepant result may be confirmed with PCR. Laboratory tests detecting GTD alone or only Tox A are of no diagnostic use; because of poor positive predictive value Discrepant test samples which may be GDH pos/tox neg or vice- versa may be further confirmed by Xpert PCR.

Objective: The main objective was to identify the rate of C. difficile infection.

Methodology: Two hundred randomly selected gastroenteritis cases from hospitals and the community were included. In total, 145 met the inclusion criteria. C. difficile toxin and / or antigen was detected using the Techlab C.diff quik chek kit. CD antigen alone was detected in 18% (25) of cases, antigen with one of the toxin was found in 21% (30). Overall, the Nosocomial CDI rate in adults was 34% (17/50). The carriage rate in children was 31% (11/ 35).

Conclusion: C. difficile diarrhea is an emerging problem in India.

Author(s): G.S. Vijay Kumar, B.M. Uma

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