title: Elevated lactoferrin is associated with moderate to severe Clostridium difficile disease, stool toxin, and 027 infection.
abstract: We evaluated blood and fecal biomarkers as indicators of severity in symptomatic patients with confirmed Clostridium difficile infection (CDI). Recruitment included patients with CDI based on clinical symptoms and supporting laboratory findings. Disease severity was defined by physician's assessment and blood and fecal biomarkers were measured. Toxigenic culture done using spore enrichment and toxin B detected by tissue culture were done as confirmatory tests. Polymerase chain reaction (PCR) ribotyping was performed on each isolate. There were 98 patients recruited, with 85 (87%) confirmed cases of toxigenic CDI (21 severe, 57 moderate, and seven mild), of which 68 (80%) were also stool toxin-positive. Elevated lactoferrin (p = 0.01), increased white blood cell (WBC) count (p = 0.08), and low serum albumin (p = 0.03) were all associated with the more severe cases of CDI. Ribotype 027 infection accounted for 71% of severe cases (p < 0.01) and patients with stool toxin had significantly higher lactoferrin levels and WBC counts (p < 0.05). Our findings show that elevated fecal lactoferrin, along with increased WBC count and low serum albumin, were associated with more severe CDI. In addition, patients infected with ribotype 027 and those with stool toxin had significantly higher fecal lactoferrin and WBC counts.
authors.affiliation: Research and Development, TechLab, Inc., 2001 Kraft Drive, Blacksburg, VA, 24060, USA, jhboone@techlab.com.
authors.forename: J H
authors.initials: JH
authors.lastname: Boone
authors.forename: J R
authors.initials: JR
authors.lastname: DiPersio
authors.forename: M J
authors.initials: MJ
authors.lastname: Tan
authors.forename: S-J
authors.initials: SJ
authors.lastname: Salstrom
authors.forename: K N
authors.initials: KN
authors.lastname: Wickham
authors.forename: R J
authors.initials: RJ
authors.lastname: Carman
authors.forename: H R
authors.initials: HR
authors.lastname: Totty
authors.forename: R E
authors.initials: RE
authors.lastname: Albert
authors.forename: D M
authors.initials: DM
authors.lastname: Lyerly
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001427:Bacterial Toxins / Q000097:blood / Q000378:metabolism*; D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000097:blood / Q000201:enzymology / Q000378:metabolism* / Q000382:microbiology; D005243:Feces / Q000737:chemistry / Q000382:microbiology; D005260:Female; D006801:Humans; D007781:Lactoferrin / Q000097:blood / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D021521:Ribotyping; D012709:Serum Albumin / Q000378:metabolism
chemical_list: D001427:Bacterial Toxins; D015415:Biomarkers; D012709:Serum Albumin; D007781:Lactoferrin