Comparison of clinical, microbiologic, and clinicopathologic findings in horses positive and negative for Clostridium difficile infection.
OBJECTIVE
To compare clinical, microbiologic, and clinicopathologic findings among horses infected with Clostridium difficile that had toxin A in their feces, horses with evidence of C difficile infection that were negative for toxin A in their feces, and horses with diarrhea that were negative for C difficile infection.


METHODS
Cross-sectional study.


METHODS
292 horses and foals with diarrhea.


METHODS
Feces were submitted for microbial culture and tested for the C difficile antigen glutamate dehydrogenase and for toxin A with a commercial ELISA.


RESULTS
Horses with toxin A in their feces had higher band neutrophil count, rectal temperature, hospitalization time prior to the onset of diarrhea, and total hospitalization time than did horses without evidence of C difficile infection, and 32 of the 33 (97%) horses with toxin A in their feces had received antimicrobials prior to the onset of diarrhea. Horses with toxin A in their feces had a significantly higher mortality rate than did horses negative for toxin A in their feces. Sensitivity and specificity of the ELISA for detection of C difficile antigen were 93% and 88%, when assay results were compared with results of microbial culture following direct plating, and 66% and 93%, when assay results were compared with results of microbial culture following broth enrichment.


CONCLUSIONS
Results provided some evidence that horses positive for toxin A had more severe clinical disease than did horses with evidence of C difficile infection that were negative for toxin A and horses with diarrhea without evidence of C difficile infection.
Ruby
Rebecca
R
Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA 95616, USA.
Magdesian
K Gary
KG
Kass
Philip H
PH
D000818:Animals; D001427:Bacterial Toxins / Q000302:isolation & purification*; D016360:Clostridioides difficile / Q000302:isolation & purification / Q000378:metabolism; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000382:microbiology / Q000401:mortality / Q000473:pathology / Q000662:veterinary*; D004761:Enterocolitis, Pseudomembranous / Q000382:microbiology / Q000401:mortality / Q000473:pathology / Q000662:veterinary*; D004768:Enterotoxins / Q000302:isolation & purification*; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods / Q000662:veterinary; D005243:Feces / Q000737:chemistry* / Q000201:enzymology / Q000382:microbiology; D005260:Female; D005969:Glutamate Dehydrogenase / Q000378:metabolism; D006734:Horse Diseases / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D006736:Horses; D006760:Hospitalization; D008297:Male; D012720:Severity of Illness Index
D001427:Bacterial Toxins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile; D005969:Glutamate Dehydrogenase