Fatal pseudomembranous colitis associated with a variant clostridium difficile strain not detected by toxin A immunoassay.
Ann Intern Med
; 135(6): 434-8, 2001 Sep 18.
Article
em En
| MEDLINE
| ID: mdl-11560456
ABSTRACT
BACKGROUND:
Many clinical laboratories use toxin A immunoassays to test for Clostridium difficile.OBJECTIVE:
To describe the clinical course of a patient infected with a toxin variant strain of C. difficile that was not detected by toxin A immunoassay; to genetically characterize this strain; and to estimate the number of laboratories that use only toxin A immunoassays.DESIGN:
Case report, molecular investigation, and laboratory survey.SETTING:
Tertiary care hospital in Chicago, Illinois. PATIENT An 86-year-old man. MEASUREMENTS Restriction endonuclease analysis, polymerase chain reaction, and survey of regional clinical laboratories.RESULTS:
An elderly hospitalized man died of advanced pseudomembranous colitis. Four stool specimens submitted over a 2-month period had tested negative on toxin A immunoassay, but a strain of C. difficile with a 1.8-kb deletion of the toxin A gene was recovered from each specimen. This strain, identified as restriction endonuclease analysis type CF4, is closely related to a widely disseminated variant, toxinotype VIII. Toxin A immunoassay was the only test being performed for detection of C. difficile at 31 of 67 (46%) regional clinical laboratories.CONCLUSIONS:
Toxin A variant strains of C. difficile cause serious disease and are undetectable in clinical laboratories that use only toxin A immunoassays for C. difficile testing.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Enterocolite Pseudomembranosa
/
Clostridioides difficile
Tipo de estudo:
Diagnostic_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Aged80
/
Humans
/
Male
Idioma:
En
Revista:
Ann Intern Med
Ano de publicação:
2001
Tipo de documento:
Article
País de afiliação:
Estados Unidos