Stool C difficile toxin

Definition

The stool C difficile toxin test detects harmful substances produced by the bacterium Clostridioides difficile (C difficile). This infection is a common cause of diarrhea after antibiotic use.

Alternative Names

Antibiotic associated colitis - toxin; Colitis - toxin; Pseudomembranous - toxin; Necrotizing colitis - toxin; C difficile - toxin

How the Test is Performed

A stool sample is needed. It is sent to a lab to be analyzed. There are several ways to detect C difficile toxin in the stool sample.

Enzyme immunoassay (EIA) is most often used to detect substances produced by the bacteria. This test is faster than older tests, and simpler to perform. The results are ready in a few hours. However, it is slightly less sensitive than earlier methods. Several stool samples may be needed to get an accurate result.

A newer method is to use PCR to detect the toxin genes. This is the most sensitive and specific test. Results are ready within 1 hour. Only one stool sample is needed.

How to Prepare for the Test

There are many ways to collect the samples.

• You can catch the stool on plastic wrap that is loosely placed over the toilet bowl and held in place by the toilet seat. Then you put the sample in a clean container.
• A test kit is available that supplies a special toilet tissue that you use to collect the sample. After collecting the sample, you put it in a container.

Do not mix urine, water, or toilet tissue with the sample.

For children wearing diapers:

• Line the diaper with plastic wrap.
• Position the plastic wrap so that it will prevent urine and stool from mixing. This will provide a better sample.

Why the Test is Performed

You may have this test if your health care provider thinks that diarrhea is caused by the antibiotic medicines you have taken recently. Antibiotics change the balance of bacteria in the colon. This sometimes leads to too much growth of C difficile.

Diarrhea caused by C difficile after antibiotic use often occurs in people who are in the hospital. It also can occur in people who have not recently taken antibiotics. This condition is called pseudomembranous colitis.

Normal Results

No C difficile toxin is detected.

Note: Normal value ranges may vary slightly among different laboratories. Talk to your provider about the meaning of your specific test results.

What Abnormal Results Mean

Abnormal results mean that toxins produced by C difficile are seen in the stool and are causing diarrhea.

Risks

There are no risks associated with testing for C difficile toxin.

Considerations

Several stool samples may be needed to detect the condition. This is particularly true if the older EIA for toxin test is used.

References

Beavis KG, Charnot-Katsikas A. Specimen collection and handling for diagnosis of infectious diseases. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 23rd ed. St Louis, MO: Elsevier; 2017:chap 64.

Dupont HL. Approach to the patient with suspected enteric infection. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 283.

Gerding DN, Johnson S. Clostridial infections. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 296.

Gerding DN, Young VB. Clostridium difficle infection. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 245.

Haines CF, Sears CL. Infectious enteritis and proctocolitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 110.

Semrad CE. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 140.

Siddiqi HA, Salwen MJ, Shaikh MF, Bowne WB. Laboratory diagnosis of gastrointestinal and pancreatic disorders. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 23rd ed. St Louis, MO: Elsevier; 2017:chap 22.