Review of frequency-pulsed electron-capture gas-liquid chromatography studies of diarrheal diseases caused by members of the family Enterobacteriaceae, Clostridium difficile, and rotavirus

A novel method for rapidly diagnosing the causes of diarrhoea

BACKGROUND

The microbiological diagnosis of infectious diarrhoea may take several days using conventional techniques. In order to determine whether flatus can be used to make a rapid diagnosis, the volatile organic compounds associated with diarrhoea were analysed.

METHODS

Stool samples were collected from 35 patients with infectious diarrhoea and from six healthy controls. Gaseous compounds were extracted from a headspace using solid phase microextraction and analysed using gas chromatography and mass spectroscopy.

RESULTS

Characteristic patterns of volatile gases were found for the main causes of infectious diarrhoea in hospitals. Furan species without indoles indicated Clostridium difficile, ethyl dodecanoate indicated rotavirus, ammonia without ethyl dodecanoate suggested other enteric viruses, and the absence of hydrocarbons and terpenes indicated Campylobacter infection.

CONCLUSION

These results could be the basis of rapid near patient diagnosis of infectious diarrhoea.

Detection of malignancy-associated metabolites in the sera of cancer patients by electron capture gas chromatography

A reliable test that detects malignancy and indicates response to therapy is needed. Frequency-pulsed electron-capture gas-liquid chromatography (FPEC-GLC), a selective analytical technique that is sensitive to 15 fmol quantities of metabolites, was used to analyse derivatised acidic chloroform extracts of sera from patients with biopsy-proven cancer, non-malignant infectious and non-infectious disease, and healthy controls. Two peaks designated P1 and P10, not found in serum from healthy controls (n = 7) or patients with non-malignant disease (n = 85), were detected in biopsy-proven samples (n = 52) from cancer patients. P1 and P10 were later shown by chemical and mass spectral studies to be carboxylic acids. When one or both of these peaks were detected in the sera of non-treated patients they were always associated with malignancy. In patients responding to therapy, a reduction or disappearance of these peaks was observed. Further, it was noted that P10 persisted or increased in sera of patients with progressive cancer not responding to therapy. We conclude that this test has potential in diagnosis and for following the response of the disease to therapy.

Clostridium difficile: clinical disease and diagnosis

Clostridium difficile is an opportunistic pathogen that causes a spectrum of disease ranging from antibiotic-associated diarrhea to pseudomembranous colitis. Although the disease was first described in 1893, the etiologic agent was not isolated and identified until 1978. Since clinical and pathological features of C. difficile-associated disease are not easily distinguished from those of other gastrointestinal diseases, including ulcerative colitis, chronic inflammatory bowel disease, and Crohn's disease, diagnostic methods have relied on either isolation and identification of the microorganism or direct detection of bacterial antigens or toxins in stool specimens. The current review focuses on the sensitivity, specificity, and practical use of several diagnostic tests, including methods for culture of the etiologic agent, cellular cytotoxicity assays, latex agglutination tests, enzyme immunoassay systems, counterimmunoelectrophoresis, fluorescent-antibody assays, and polymerase chain reactions.

Applications of cellular fatty acid analysis

More than ever, new technology is having an impact on the tools of clinical microbiologists. The analysis of cellular fatty acids by gas-liquid chromatography (GLC) has become markedly more practical with the advent of the fused-silica capillary column, computer-controlled chromatography and data analysis, simplified sample preparation, and a commercially available GLC system dedicated to microbiological applications. Experience with applications in diagnostic microbiology ranges from substantial success in work with mycobacteria, legionellae, and nonfermentative gram-negative bacilli to minimal involvement with fungi and other nonbacterial agents. GLC is a good alternative to other means for the identification of mycobacteria or legionellae because it is rapid, specific, and independent of other specialized testing, e.g., DNA hybridization. Nonfermenters show features in their cellular fatty acid content that are useful in identifying species and, in some cases, subspecies. Less frequently encountered nonfermenters, including those belonging to unclassified groups, can ideally be characterized by GLC. Information is just beginning to materialize on the usefulness of cellular fatty acids for the identification of gram-positive bacteria and anaerobes, despite the traditional role of GLC in detecting metabolic products as an aid to identification of anaerobes. When species identification of coagulase-negative staphylococci is called for, GLC may offer an alternative to biochemical testing. Methods for direct analysis of clinical material have been developed, but in practical and economic terms they are not yet ready for use in the clinical laboratory. Direct analysis holds promise for detecting markers of infection due to an uncultivable agent or in clinical specimens that presently require cultures and prolonged incubation to yield an etiologic agent.

Identification of Clostridium difficile in stool specimens by culture-enhanced gas-liquid chromatography

We have developed a sensitive and specific method for the identification of Clostridium difficile in stool specimens based on the detection of metabolic breakdown products of the organism by gas-liquid chromatography after incubation of stool samples in a selective broth medium containing cefoxitin. Use of this approach to test samples from two different populations of patients at separate medical centers showed this method to be superior to plate cultures or cytotoxin testing alone for both populations. The combined results from the two patient populations showed that 225 of 226 confirmed isolates were identified correctly, resulting in a sensitivity of 99.6% and a specificity of 99.0%. This method eliminates the delay caused by subculturing for tests requiring a pure isolate. The culture phase amplifies even low numbers of C. difficile in fecal samples (due to low in vivo concentrations or delayed transport) and thus increases sensitivity. Other advantages include the ability to detect C. difficile in the mixed flora of the stool and the ability of most clinical laboratories to use this procedure. Given the complexities of the detection of C. difficile toxins and the increasing importance of this organism as a nosocomial agent, culture-based methods remain the preferred approach to screening and routine workup for cases of diarrhea.

Gas chromatographic-mass spectral studies after methylation of metabolites produced by some anaerobic bacteria in spent media

The gas chromatographic analysis of metabolites such as volatile fatty acids (VFAs) and non-volatile fatty acids (NVFAs) for identification of anaerobic bacteria is now widely performed. Cultures of anaerobes tested for NVFAs as methyl esters were found to contain several unidentified compounds not previously detected and/or reported with methylation procedures. Gas chromatographic-mass spectrometric studies demonstrated that these compounds correspond to the methyl esters of both saturated and unsaturated short-chain fatty acids, and also of 2-hydroxy and 2-oxo acids. The distribution of these acids among different species of anaerobes was determined and their amounts were measured. The effects of supplementing the culture medium with either glucose or amino acids on the production of these acids are described. The use of very polar stationary phases is suggested for a better separation of all NVFAs.

Studies of metabolites in diarrheal stool specimens positive for Klebsiella, Serratia, and Proteus spp. by frequency-pulsed electron-capture gas chromatography

Diarrheal stools from infants from which Klebsiella pneumoniae, Serratia liquefaciens, and Proteus mirabilis were isolated as possible causative agents of diarrhea were studied. These stools, along with control stool specimens which were collected from infants in the same village of Tamooh (near Cairo, Egypt), were analyzed by frequency-pulsed electron-capture gas chromatography (FPEC-GC). Watery stools and formed stools, to which distilled water was added, were centrifuged, and the supernatant was extracted with organic solvents and derivatized with specific functional group reagents to form electron-absorbing derivatives of carboxylic acids, hydroxy acids, alcohols, and amines. Results from the study showed distinct differences in FPEC-GC profiles of stools positive for K. pneumoniae, S. liquefaciens, and P. mirabilis. The major differences found were that diarrheal stools from which K. pneumoniae was isolated contained acetoin, a hydroxy acid-labeled peak F, and an unidentified amine, peak A. S. liquefaciens diarrheal stools had FPEC-GC profiles like the controls with the exception that an amine, peak A, was detected. The diarrhel stools containing P. mirabilis produced a distinct amine profile.