title: Diagnostic role of stool culture & toxin detection in antibiotic associated diarrhoea due to Clostridium difficile in children.
abstract: OBJECTIVE
  Mere diagnosis of Clostridium difficile by culture does not help in the diagnosis of antibiotic associated diarrhoeae (AAD) due to C. difficile. Detection of toxins A and B form the mainstay in the diagnosis of AAD due to C. difficile. This study was undertaken to find out the role of stool culture and toxin detection in the diagnosis of AAD due to C. difficile. As there are very few documented reports from India about AAD due to C. difficile in children in the age group of 5-12 yr, this age group was selected.
  
  
  METHODS
  Faecal samples were collected from 250 hospitalized children in the age group of 5-12 yr who developed diarrhoea on receiving antibiotics for different medical problems for more than five days duration. Also faecal samples of 250 age and sex matched controls were collected. Culture for C. difficile was done on cycloserine cefoxitin fructose egg yolk agar (CCFA) and colonies were identified by standard laboratory techniques. ELISA for toxins A and B detection and tissue culture on HeLa cells for toxin B detection were also done.
  
  
  RESULTS
  Overall positivity was 18 per cent in this study group compared to the controls (P<0.001). Maximum positive cases were in 5-8 yr age group (84.4%). Severe diarrhoea, liquid stool with mucus and blood, faecal leucocytes >5/high power field, altered flora and presence of Gram-positive bacilli with oval subterminal spores on Gram stain were sensitive predictors for diagnosis of AAD due to C. difficile. Amongst positive cases, 68.9 per cent responded to discontinuation of antibiotics and 31.1 per cent to metronidazole therapy.
  
  
  CONCLUSIONS
  C. difficile was an important pathogen responsible for antibiotic associated diarrhoea (AAD) in children of 5-12 yr age group. Conservative use of antibiotics would be beneficial to decrease the incidence of AAD.
authors.affiliation: Department of Microbiology , L.T.M. Medical College, Mumbai, India.
authors.forename: A
authors.initials: A
authors.lastname: Gogate
authors.forename: A
authors.initials: A
authors.lastname: De
authors.forename: R
authors.initials: R
authors.lastname: Nanivadekar
authors.forename: M
authors.initials: M
authors.lastname: Mathur
authors.forename: K
authors.initials: K
authors.lastname: Saraswathi
authors.forename: A
authors.initials: A
authors.lastname: Jog
authors.forename: M V
authors.initials: MV
authors.lastname: Kulkarni
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D001426:Bacterial Proteins / Q000032:analysis; D001427:Bacterial Toxins / Q000032:analysis; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000302:isolation & purification / Q000472:pathogenicity; D003015:Clostridium Infections / Q000175:diagnosis* / Q000188:drug therapy; D003967:Diarrhea / Q000139:chemically induced / Q000209:etiology* / Q000382:microbiology; D004768:Enterotoxins / Q000032:analysis; D005243:Feces / Q000737:chemistry / Q000382:microbiology; D005260:Female; D006801:Humans; D007194:India; D008297:Male
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile