Clostridium difficile: A Neglected, but Emerging Pathogen in India

Background: C. difficile (CD) is a common pathogen causing antibiotic-associated diarrhea in the US and Europe, but is a neglected enteric pathogen in India. During the last decade this organism has become the leading enteric pathogen causing antibiotic-associated diarrhea in Nosocomial and community populations. Laboratory confirmation is the only method of detecting C. difficile. Different laboratory test methods include enzyme immunoassays (EIAs), lateral flow tests, PCR assays, tissue culture cytotoxicity neutralization tests and toxigenic culture. Sensitivity, specificity, turnaround time and cost effectiveness of these tests differs grossly. The Tech lab C. difficile quik chek complete kit (USA) is the only commercial diagnostic lateral flow rapid kit detecting Glutamate deHydrogenase (GDH) and CD toxin simultaneously in a single test cassette. Comparative analysis of Techlab kit with cytotoxicity assay showed 88% predictive rate. The test is easy, rapid and has good specificity. Tech lab kit can be used for screening and any discrepant result may be confirmed with PCR. Laboratory tests detecting GTD alone or only Tox A are of no diagnostic use; because of poor positive predictive value Discrepant test samples which may be GDH pos/tox neg or viceversa may be further confirmed by Xpert PCR.