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Hulme JP. Emerging Diagnostics in Clostridioides difficile Infection. Int J Mol Sci 2024; 25:8672. [PMID: 39201359 PMCID: PMC11354687 DOI: 10.3390/ijms25168672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 08/06/2024] [Accepted: 08/07/2024] [Indexed: 09/02/2024] Open
Abstract
Clostridioides difficile detection in community settings is time-intensive, resulting in delays in diagnosing and quarantining infected individuals. However, with the advent of semi-automated devices and improved algorithms in recent decades, the ability to discern CDI infection from asymptomatic carriage has significantly improved. This, in turn, has led to efficiently regulated monitoring systems, further reducing endemic risk, with recent concerns regarding a possible surge in hospital-acquired Clostridioides difficile infections post-COVID failing to materialize. This review highlights established and emerging technologies used to detect community-acquired Clostridioides difficile in research and clinical settings.
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Affiliation(s)
- John P Hulme
- Department of Bio-Nano Technology, Gachon University, Seongnam-si 13120, Republic of Korea
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Maestri AC, Nogueira KS, Mialski R, Dos Santos EM, Kraft L, Raboni SM. Laboratory diagnosis of Clostridioides difficile infection in symptomatic patients: what can we do better? Braz J Microbiol 2023; 54:849-857. [PMID: 36991280 PMCID: PMC10234961 DOI: 10.1007/s42770-023-00956-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
The laboratory diagnosis of Clostridioides difficile infection (CDI) is challenging since this bacteria may be detected in healthy people and toxin production detection is not sensitive enough to be used alone. Thus, there is no single test with adequate sensitivity and specificity to be used in laboratory diagnosis. We evaluated the performance of tests used in the diagnosis of CDI in symptomatic patients with risk factors in hospitals in southern Brazil. Enzyme immunoassays (EIA) for glutamate dehydrogenase antigen (GDH) and toxins A/B, real-time polymerase chain reaction (qPCR), GeneXpert system, and a two-step algorithm comprising GDH/TOXIN EIA performed simultaneously followed by GeneXpert for outliers were evaluated. Toxigenic strain in stool culture was considered CDI positive (gold standard). Among 400 samples tested, 54 (13.5%) were positive for CDI and 346 (86.5%) were negative. The diagnosis of the two-step algorithm and qPCR had an excellent performance with an accuracy of 94.5% and 94.2%, respectively. The Youden index showed that GeneXpert as a single test (83.5%) and the two-step algorithm (82.8%) were the most effective assays. Diagnosing CDI and non-CDI diarrhea could be successfully attained by the combination of clinical data with accuracy of laboratory tests.
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Affiliation(s)
- Adriane C Maestri
- , Laboratório de Bacteriologia, Complexo Hospital de Clínicas da Universidade Federal do Paraná, Rua Padre Camargo, 280-Alto da Glória, CEP: 80.062-240, Curitiba, Paraná, Brazil
- Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde, Universidade Federal do Paraná, Rua General Carneiro, 181-Alto da Glória, CEP-80060-900, Curitiba, Paraná, Brazil
| | - Keite S Nogueira
- , Laboratório de Bacteriologia, Complexo Hospital de Clínicas da Universidade Federal do Paraná, Rua Padre Camargo, 280-Alto da Glória, CEP: 80.062-240, Curitiba, Paraná, Brazil
- Departamento de Patologia Básica, Universidade Federal do Paraná, Centro Politecnico, Av. Cel. Francisco H. dos Santos, 100-Jardim das Americas, CEP-81531-980, Curitiba, Paraná, Brazil
| | - Rafael Mialski
- Departamento de Infectologia, Complexo Hospital de Clínicas da Universidade Federal do Paraná, Rua General Carneiro, 181-Alto da Glória, CEP-80060-900, Curitiba, Paraná, Brazil
| | - Erika Medeiros Dos Santos
- Hospital Pequeno Principe, Rua Desembargador Motta, 1070-Agua Verde, Curitiba-PR, 80250-060, Brazil
- Instituto de Pesquisa Pele Pequeno Principe, Av. Silva Jardim, 1632-Agua Verde, Curitiba-PR, 80250-060, Brazil
| | - Leticia Kraft
- Hospital Pequeno Principe, Rua Desembargador Motta, 1070-Agua Verde, Curitiba-PR, 80250-060, Brazil
| | - Sonia M Raboni
- Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde, Universidade Federal do Paraná, Rua General Carneiro, 181-Alto da Glória, CEP-80060-900, Curitiba, Paraná, Brazil.
- Departamento de Infectologia, Complexo Hospital de Clínicas da Universidade Federal do Paraná, Rua General Carneiro, 181-Alto da Glória, CEP-80060-900, Curitiba, Paraná, Brazil.
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Raeisi H, Azimirad M, Asadzadeh Aghdaei H, Yadegar A, Zali MR. Rapid-format recombinant antibody-based methods for the diagnosis of Clostridioides difficile infection: Recent advances and perspectives. Front Microbiol 2022; 13:1043214. [PMID: 36523835 PMCID: PMC9744969 DOI: 10.3389/fmicb.2022.1043214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/13/2022] [Indexed: 08/30/2023] Open
Abstract
Clostridioides difficile, the most common cause of nosocomial diarrhea, has been continuously reported as a worldwide problem in healthcare settings. Additionally, the emergence of hypervirulent strains of C. difficile has always been a critical concern and led to continuous efforts to develop more accurate diagnostic methods for detection of this recalcitrant pathogen. Currently, the diagnosis of C. difficile infection (CDI) is based on clinical manifestations and laboratory tests for detecting the bacterium and/or its toxins, which exhibit varied sensitivity and specificity. In this regard, development of rapid diagnostic techniques based on antibodies has demonstrated promising results in both research and clinical environments. Recently, application of recombinant antibody (rAb) technologies like phage display has provided a faster and more cost-effective approach for antibody production. The application of rAbs for developing ultrasensitive diagnostic tools ranging from immunoassays to immunosensors, has allowed the researchers to introduce new platforms with high sensitivity and specificity. Additionally, DNA encoding antibodies are directly accessible in these approaches, which enables the application of antibody engineering to increase their sensitivity and specificity. Here, we review the latest studies about the antibody-based ultrasensitive diagnostic platforms for detection of C. difficile bacteria, with an emphasis on rAb technologies.
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Affiliation(s)
- Hamideh Raeisi
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Azimirad
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Asadzadeh Aghdaei
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Yadegar
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bankur MN, Keeling A, Adil Shah KM, Avenoso D. CMV Colitis: A Rare Complication of Azacitidine and Venetoclax Chemotherapy. Hematol Rep 2022; 14:213-221. [PMID: 35893153 PMCID: PMC9326678 DOI: 10.3390/hematolrep14030029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/12/2022] [Accepted: 06/13/2022] [Indexed: 12/18/2022] Open
Abstract
Herein, we present a case of cytomegalovirus (CMV) colitis that occurred after two cycles of azacitidine and venetoclax in a 64-year-old woman affected with acute myeloid leukaemia (AML) secondary to a previous diagnosis of a hypoplastic myelodysplastic syndrome (hypo-MDS). This patient never had detectable CMV viraemia, and there was no evidence of immune deficiency that could justify this opportunistic infection. Additionally, this is most likely the first report describing CMV colitis in a patient treated upfront with azacitidine and venetoclax.
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Affiliation(s)
- Mustafa Nissar Bankur
- Department of Haematological Medicine, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK;
- Neurosciences Department, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Archie Keeling
- Radiology Department, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK;
| | | | - Daniele Avenoso
- Department of Haematological Medicine, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK;
- Correspondence:
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Carvalho GM, Ramos CP, Lobato FCF, Guedes RMC, Giaretta PR, Silva ROS. Laboratory diagnosis of Clostridioides (Clostridium) difficile infection in domestic animals: A short review. Anaerobe 2022; 75:102574. [PMID: 35472506 DOI: 10.1016/j.anaerobe.2022.102574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/24/2022] [Accepted: 04/17/2022] [Indexed: 12/18/2022]
Abstract
Despite the known importance of Clostridioides (Clostridium) difficile infection (CDI) in animals, there are no published guidelines for the diagnosis of CDI. The performance of the available commercial methods, all standardized for human stool samples, can vary according to the animal species. Thus, the aim of the present study was to review the literature on the detection of C. difficile in pigs, horses, and dogs. The detection of toxins A and B using enzyme immunoassays seems to have low performance in piglet and dog samples, while it shows high sensitivity for the diagnosis of CDI in foals. On the other hand, tests for the detection of glutamate dehydrogenase (GDH) have a high sensitivity towards detection of C. difficile in animal samples, suggesting that it can be an adequate screening method. A few studies have evaluated real-time PCR or nucleic acid amplification tests in animal samples and, so far, these methods have also shown a low performance for the detection of C. difficile in animals. Although the intestinal lesions caused by CDI can vary among animal species, histopathology can be a useful auxiliary tool for postmortem diagnosis in animals.
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Affiliation(s)
- Gabriela Muniz Carvalho
- Veterinary School, Universidade Federal de Minas Gerais (UFMG), Avenida Antônio Carlos, 6627. Belo Horizonte, MG, CEP, 31270-901, Brazil
| | - Carolina Pantuzza Ramos
- Veterinary School, Universidade Federal de Minas Gerais (UFMG), Avenida Antônio Carlos, 6627. Belo Horizonte, MG, CEP, 31270-901, Brazil
| | - Francisco Carlos Faria Lobato
- Veterinary School, Universidade Federal de Minas Gerais (UFMG), Avenida Antônio Carlos, 6627. Belo Horizonte, MG, CEP, 31270-901, Brazil
| | - Roberto Maurício Carvalho Guedes
- Veterinary School, Universidade Federal de Minas Gerais (UFMG), Avenida Antônio Carlos, 6627. Belo Horizonte, MG, CEP, 31270-901, Brazil
| | - Paula Roberta Giaretta
- Veterinary School, Universidade Federal de Minas Gerais (UFMG), Avenida Antônio Carlos, 6627. Belo Horizonte, MG, CEP, 31270-901, Brazil
| | - Rodrigo Otávio Silveira Silva
- Veterinary School, Universidade Federal de Minas Gerais (UFMG), Avenida Antônio Carlos, 6627. Belo Horizonte, MG, CEP, 31270-901, Brazil.
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Ramos CP, Diniz AN, Leite SM, Lobato FCF, Pereira ST, Rennó MC, de Oliveira Ferreira E, Silva ROS. Evaluation of an immunochromatographic test for the detection of glutamate dehydrogenase for the diagnosis of Clostridioides (Clostridium) difficile infection in dogs. Braz J Microbiol 2021; 52:2555-2558. [PMID: 34562233 PMCID: PMC8578347 DOI: 10.1007/s42770-021-00615-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/19/2021] [Indexed: 01/05/2023] Open
Abstract
This study aimed to evaluate an immunochromatographic test used to detect glutamate dehydrogenase (GDH) for the diagnosis of Clostridium difficile infection (CDI) in dogs. Fecal samples of 119 diarrheic dogs were subjected to toxigenic culture as the "gold standard" method and to GDH detection (Ecodiagnostica, Brazil). Samples positive for toxigenic C. difficile strains and those positive in the GDH test were also subjected to A/B toxin detection using an enzyme immunoassay kit (C. difficile Tox A/B II, Techlab Inc., USA). Sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) were measured for GDH detection and compared with the toxigenic culture results. A total of 19 (15.9%) dogs were positive for toxigenic C. difficile. Of these, 10 (52.6%) dogs were positive for A/B toxins using the enzyme immunoassay kit and 18 (15.2%) were positive in the GDH test, leading to a sensitivity and NPV of 89.4% and 97.9%, respectively. Three animals, two of which were colonized with non-toxigenic strains, were positive for GDH, though not confirmed with CDI, resulting in a high specificity (97%) and PPV (85%). The results suggest that the lateral flow test for GDH detection could be a useful method for diagnosing CDI in dogs, similar to that previously described for humans and other animal species.
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Affiliation(s)
- Carolina Pantuzza Ramos
- Veterinary School, Universidade Federal de Minas Gerais, Antônio Carlos Avenue, 6627, Belo Horizonte, MG, 31.270-901, Brazil
| | - Amanda Nádia Diniz
- Veterinary School, Universidade Federal de Minas Gerais, Antônio Carlos Avenue, 6627, Belo Horizonte, MG, 31.270-901, Brazil
| | - Suzana Martins Leite
- IMPG, Depto. de Microbiologia Médica, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Francisco Carlos Faria Lobato
- Veterinary School, Universidade Federal de Minas Gerais, Antônio Carlos Avenue, 6627, Belo Horizonte, MG, 31.270-901, Brazil
| | | | | | | | - Rodrigo Otávio Silveira Silva
- Veterinary School, Universidade Federal de Minas Gerais, Antônio Carlos Avenue, 6627, Belo Horizonte, MG, 31.270-901, Brazil.
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Cançado GGL, Abreu ESD, Nardelli MJ, Serwa P, Brachmann M. A cost of illness comparison for toxigenic Clostridioides difficile diagnosis algorithms in developing countries. Anaerobe 2021; 70:102390. [PMID: 34058377 DOI: 10.1016/j.anaerobe.2021.102390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/16/2021] [Accepted: 05/17/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Availability of several commercial tests with different Clostridioides difficile targets contributes to uncertainty and controversies around the optimal diagnostic algorithm. While numerous studies have estimated the financial impact of C. difficile infection, models to guide testing strategies decisions in developing countries, where economic value significantly impacts clinical practice, are currently not available. AIM To determine the cost of illness of different C. difficile infection (CDI) diagnostic strategies in developing countries. METHODS Cost-comparison analysis was performed to compare eleven different algorithms of CDI diagnosis. The basis of calculation was a hypothetical cohort of 1000 adult inpatients suspected of CDI. We analyzed turnaround time of test results (i.e., time from taking sample to results emission), test performance (i.e., sensitivity and specificity) and testing costs. Patients were divided in true positive, false positive, true negative and false negative in order to integrate test performance and economics effects. Additional medical costs were calculated: costs of hygiene, medication, length of stay and intensive care unit costs, based on a Brazilian University Hospital costs. CDI prevalence was considered 22.64%. FINDINGS From laboratory-assisted tests, simultaneous glutamate dehydrogenase (GDH) and toxin A/B rapid immunoassay arbitrated by nucleic acid amplification test (NAAT) presented the lowest cost of illness (450,038.70 USD), whereas standalone NAAT had the highest (523,709.55 USD). Empirical diagnosis only presented the highest overall cost (809,605.44 USD). CONCLUSION The two-step algorithm with simultaneous GDH and toxin A/B rapid immunoassay arbitrated by NAAT seems to be the best strategy for CDI diagnosis in developing countries.
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Affiliation(s)
- Guilherme Grossi Lopes Cançado
- Hospital Das Clínicas da Universidade Federal de Minas Gerais, Minas Gerais, Brazil; Hospital da Polícia Militar de Minas Gerais, Minas Gerais, Brazil.
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