Diagnosis of Clostridium Difficile
Clostridium Difficile Infection is currently the most commonly found cause of diarrhoea in relation to antibiotic treatments in hospitals. Although C.difficile infections are common, there are only a limited methods of diagnosing accurately if a patient has been affected. I will be discussing methods of diagnosis, pros and cons and statistical facts regarding C.difficile infection.
METHODS OF LABORATORY DIAGNOSIS
There are several methods of diagnosing if a patient is infected by C.difficile Although there are 5 different methods of detection which could in theory lead to a positive diagnosis; but only three out of the five, faecal-cytotoxin detection (Mollby R et al 1985), toxigenic culture detection and direct gas liquid chromatography (GLC), are considered to be procedures providing firm positive result for standard diagnosis to be made (BRAZIER 1998). The other two, Latex agglutination and computed tomography scan are also tests carried out to diagnose the presence of C.difficile, but they are insufficiently sensitive nor specific on their own thus these tests are commonly used in conjunction with other methods of testing.
In order for a precise bacteriological diagnosis, stool samples provided must be in the form of a liquid, freshly obtained and kept at 4°C or less. The test sample must be fresh and kept at low temperatures due to the fact that the cytotoxin activity drastically decreases over time, 20% of samples sent by post were completely inactivated according to results reported by Brazier, therefore increasing the probability of a false result being obtained. (BRAZIER 1998)
DEPENDANCE ON PRIMARY SYMPTOMS IN DIAGNOSIS OF A PATIENT
Patients maybe diagnosed with C.difficile infection if they produce diarrhoea or liquid-stools of more than 300ml in a period of 24 hours (JOHN STARR BMJ). Even though main symptoms of C.difficile infection includes chronic diarrhoea, it is not enough to diagnose a patient positive of the infection due to dependancies on other primary or secondary symptoms.
Other primary symptoms include frequent bowel movement, pyrexia, dehydration and delirium; although these symptoms are not unique for patients suffering C.difficile infection, a positive diagnosis can be made if several primary symptoms relevant are identified on a patient in conjunction to each other. (GEORGE W.L et al 1980)
In most cases, symptoms mentioned will appear at the start of their cycle of antibiotics or shortly after finishing. Antibiotics generally associated with C.difficile infection development are clindamycin and cephalosporins; (JOHN STARR BMJ) both are bactericidal thus they are commonly used for infections caused by bacterium. Amoxicillin may cause the same appearance of the symptoms, but is less common compared to the previous two antibiotics mentioned. (SARAH A et al 2010)
Antibiotics mentioned above lead to these symptoms being developed because they cause the original bacterial flora in the bowel to alter, which in turn leads to unbalance in competition between bacterial present in the bowel therefore allowing other bacterium such as C.difficile to thrive better. (PATIENT 2009)
UNCERTAINTY AND SECONDARY SYMPTOMS OF C.DIFFICILE
Pseudomembranous colitis is present in a prolonged exposure to the infection. The patient will show shedding of the colonic epithelium. Although this infection is commonly caused by C.difficile, Pseudomembranous colitis is not unique to patients suffering C.difficile infection. (GEORGE W.L et al 1980)
Despite the fact that C.difficile has various symptoms which allows for a diagnosis to be made by a doctor, a positive diagnosis may not be given until further laboratory testing is done; this is because the symptoms are not completely unique to C.difficile infection alone. Moreover, secondary symptoms such as pseudomembranous colitis may not be shown even if the patient is...
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