title: Polymerase chain reaction test for Clostridium difficile toxin B gene reveals similar prevalence rates in children with and without inflammatory bowel disease.
abstract: OBJECTIVE
  Clinicians often evaluate for Clostridium difficile infection (CDI) in patients with inflammatory bowel disease (IBD) presenting with exacerbations. A highly sensitive polymerase chain reaction (PCR) test for the toxin B gene of C difficile is increasingly used to diagnose CDI. The aim of this study was to determine the prevalence of positive C difficile PCR results in children and young adults with and without active IBD compared with patients with non-IBD gastrointestinal disease.
  
  
  METHODS
  Fecal samples were obtained from patients with ulcerative colitis (UC, n = 76) or Crohn disease (CD, n = 69) and 51 controls followed in our gastroenterology program. Samples were analyzed for C difficile using a PCR test for the C difficile toxin B gene (BD GeneOhm Cdiff assay). Proportions of positive tests in each group were compared using the Pearson χ2 test.
  
  
  RESULTS
  The prevalence of positive PCR results was 11.6% in patients with CD, 18.4% in patients with UC, and 11.8% in controls (P = 0.25). There were no significant differences in the prevalence of positive C difficile results among patients with IBD with and without active disease or among patients with and without diarrhea.
  
  
  CONCLUSIONS
  Positive C difficile PCR results occur with similar frequency in patients with IBD with and without active disease and in patients with other gastrointestinal diseases. A positive result in a highly sensitive PCR assay that detects low copy numbers of a toxin gene in C difficile may reflect colonization in a subset of patients with IBD, confounding clinical decision making in managing disease exacerbations.
authors.affiliation: Division of Pediatric Gastroenterology and Nutrition, Boston Children's Hospital, Boston, MA 02115, USA. esi.lamouse-smith@childrens.harvard.edu
authors.forename: Esi S N
authors.initials: ES
authors.lastname: Lamousé-Smith
authors.forename: Sarah
authors.initials: S
authors.lastname: Weber
authors.forename: Richard F
authors.initials: RF
authors.lastname: Rossi
authors.forename: Liliane J
authors.initials: LJ
authors.lastname: Neinstedt
authors.forename: Nima
authors.initials: N
authors.lastname: Mosammaparast
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Sandora
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: McAdam
authors.forename: Athos
authors.initials: A
authors.lastname: Bousvaros
mesh_terms: D000293:Adolescent; D001426:Bacterial Proteins / Q000235:genetics*; D001427:Bacterial Toxins / Q000235:genetics*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000235:genetics*; D003015:Clostridium Infections / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D003967:Diarrhea / Q000150:complications / Q000382:microbiology*; D004768:Enterotoxins / Q000235:genetics*; D005243:Feces / Q000382:microbiology; D005260:Female; D005798:Genes, Bacterial; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000382:microbiology*; D008297:Male; D016133:Polymerase Chain Reaction / Q000379:methods; D015995:Prevalence
chemical_list: D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; C031815:toxB protein, Clostridium difficile