title: Protein-losing enteropathy associated with Clostridium difficile infection.
abstract: A commercially available radial immunodiffusion assay was used to measure serum alpha-1-antitrypsin levels in stool samples from subjects aged over 60 years as a marker of protein-losing enteropathy. alpha 1-antitrypsin was found in all of 12 patients with colonoscopy-confirmed pseudomembranous colitis, 6 of 14 (43%) patients with Clostridium difficile diarrhoea without pseudomembranes, 6 of 12 (50%) nursing-home patients culture-positive for Cl difficile but negative for its cytotoxin, and none of 15 healthy control subjects. It is concluded that serum protein loss into the gastrointestinal tract can occur as a result of Cl difficile infection, that its presence correlates with the severity of disease, and that it may occur even in the absence of diarrhoea. The diagnosis of protein-losing enteropathy should be considered for all patients with Cl difficile infection, particularly elderly nursing-home patients, in whom the risk of Cl difficile disease and the frequency of severe malnutrition are high.
authors.affiliation: Division of Geriatric Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Chronic Hospital and Nursing Home, Baltimore, Maryland.
authors.forename: A H
authors.initials: AH
authors.lastname: Rybolt
authors.forename: R G
authors.initials: RG
authors.lastname: Bennett
authors.forename: B E
authors.initials: BE
authors.lastname: Laughon
authors.forename: D R
authors.initials: DR
authors.lastname: Thomas
authors.forename: W B
authors.initials: WB
authors.lastname: Greenough
authors.forename: J G
authors.initials: JG
authors.lastname: Bartlett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003013:Clostridium / Q000302:isolation & purification; D003015:Clostridium Infections / Q000150:complications / Q000175:diagnosis*; D003428:Cross Infection / Q000209:etiology; D003967:Diarrhea / Q000209:etiology; D004761:Enterocolitis, Pseudomembranous / Q000209:etiology; D005243:Feces / Q000382:microbiology; D006801:Humans; D005779:Immunodiffusion; D008875:Middle Aged; D009735:Nursing Homes; D011504:Protein-Losing Enteropathies / Q000175:diagnosis* / Q000209:etiology; D013048:Specimen Handling; D000515:alpha 1-Antitrypsin / Q000032:analysis*
chemical_list: D000515:alpha 1-Antitrypsin