2017, Number 4
Rev Mex Patol Clin Med Lab 2017; 64 (4)
Utility of protein glutamate dehydrogenase (GDH) in the diagnosis of diarrhea associated with Clostridium difficile in the laboratory
Ledesma-Martínez VM, Rueda-Cruz JA, Fierros-Uribe D, García-Preciado CJ, Santoscoy-Tovar FA, Santoscoy-Tovar LA, Santoscoy-Tovar GJ
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ABSTRACT
Introduction: Clostridium difficile (C. difficile), a Gram-positive bacillus sporulated, strict anaerobic, was identified as a pathogen in 1978 causing colon infection, manifesting itself as a diarrheal picture that frequently appears after the use of antimicrobials. C. difficile is currently the leading cause of diarrhea in hospitalized patients. The diagnosis should be based on clinical and laboratory findings. The objective of the method is to be fast, sensitive and specific. GDH is a C. difficile associated protein, since it detects producing strains and not toxins; the sensitivity of its detection is high, with values close to 90%. When compared to toxigenic culture, it has a high negative predictive value (95-100%). Objective: 1. To identify the association between GDH and ToxA and ToxB of C. difficile in patients with acute diarrhea. 2. To determine the usefulness of the GDH Protein to contribute to the presumptive diagnosis of C. difficile. Material and methods: 1,053 samples for the evaluation of toxins A-B and GDH were received during the period November 2015/August 2016, the data were retrospective including some hospital units and sampling room. The total number of samples analyzed for the study was 764. Results: We evaluated 1,053 samples of which 289 were not included, 764 (100%). And were assessed by rapid immunochromatographic qualitative technique, 620 (81.2%) of the samples were negative for toxin A-B and GDH. The total of positive samples for the detection of any of the three toxin A, B or GDH parameters was 144 (18.8%), 60 samples (7.8%) were positive for toxin A, B and GDH, 21 (2.75%) were positive for toxin A or toxin B and GDH, 13 of the samples (1.7%) tested positive for GDH-associated toxin A, 8 samples (1.04%) were positive for GDH-associated toxin B and 63 of the samples (8.24%) were positive for (GDH). Of the 144 samples, 34 (11.7%) corresponded to the hospital service, 4 samples were positive; 3 (8.8%) of the samples had reactive toxin and GDH and 1 (2.94%) positive for GDH protein. Conclusion: In the present study, the presence of toxins (A, B) and the GDH protein parameter, the probability of certainty in the diagnosis of acute diarrhea caused by C. difficile, can be associated with this diagnosis by raising its negative predictive value and the determination of GDH as a good post-infection marker, previous C. difficile infection and patient monitoring.REFERENCES
Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald C et al. Guías de práctica clínica para la infección por Clostridium difficile en adultos: actualización 2010 realizada por la Sociedad de Salud Epidemiológica de Norteamérica (SHEA) y la Sociedad de Enfermedades Infecciosas de Norteamérica (IDSA). Infection Control and Hospital Epidemiology. 2010; 31 (5): T1-T28. Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiology of America Stable URL: http://www.jstor.org/stable/10.1086/657453