Pseudomembranous Enterocolitis: Test and Diagnosis

Microbiologic testing should be performed in the following situations:

  • Symptoms consistent with Clostridium difficile infection (CDI),
    • In persons who have been treated with antibiotics in the past 60 days.
    • In persons who have risk factors
  • Any diarrhea (diarrhea) lasting more than 3 days and no other known pathogen.

Laboratory parameters 1st order – mandatory laboratory tests.

  • Screening test in the context of microbiological diagnostics: step I: sensitive test: detection of C.-. difficile-specific glutamate dehydrogenase (GDH): GDH-Ag; this is produced by both toxigenic and non-toxigenic strains (or toxin gene PCR: very sensitive and specific, but cannot distinguish active infection from colonization; however, safely excludes the presence of non-toxigenic strains)Note: CDI is considered excluded if a negative screening test is present.[In the case of a positive screening test, confirmation of CDI by:
    • Step II: specific test: detection of toxins A/B in fresh stool sample using an enzyme-linked immunoadsorption assay (EIA[if positive: CDI is considered confirmed; treatment should be givenNote: risk of overtreatment in case of a positive PCR result for Clostridium difficile infection (CDI) and negative immunological toxin detection. In this case, therapy is usually not necessary. The patient is then colonized with C. difficile, but the germs are not causative for the diarrhea].
  • Small blood count
  • Inflammatory parameters – CRP (C-reactive protein) or PCT (procalcitonin).

Laboratory parameters 2nd order – depending on the results of the history, physical examination and obligatory laboratory parameters – for differential diagnostic clarification.

  • Genotyping

* Caution. Asymptomatic germ carriers: children <2 years: 50-80% %; healthy adults: approximately 5%; hospitalized patients: approximately 30-40%.