Clostridium difficile dehydrogenase and toxin as a biomarker for monitoring infection in patients with clostridium difficile disease and differentiating carrier state from active disease
Clostridium difficile disease involves a range of clinical presentations ranging from carrier status with other causes of symptoms to mild and self-limiting diarrhea to life-threatening pseudomembranous colitis and megacolon. Cases of C. difficile are treated differently depending on the presence and then the severity of disease. Patients that are carriers may not receive treatment with concern of causing the disease. Mild to moderate cases may be treated with metronidazole while severe and relapsing cases are often treated with vancomycin or fidaxomicin. Current molecular assays are highly sensitive for detecting toxigenic C. difficile and cannot rule out carrier status. Utilization of a biomarker panel that includes C. difficile antigen (GDH), toxins A and B, and fecal lactoferrin allows clinicians to differentiate between a carrier state and active state of C. difficile and allows for monitoring to evaluate the effectiveness of treatment.
1. A method of measuring a quantity of C. difficile in a fecal sample, the method comprising:
obtaining a fecal sample from a patient infected with C. difficile;
diluting the fecal sample;
quantitatively measuring a level of C. difficile glutamate dehydrogenase (GDH) in the fecal sample, wherein a level of C. difficile GDH<1000 ng/g comprises a low level of C. difficile GDH, and wherein a level of C. difficile GDH>or equal to 1000 ng/g comprises a high level of C. difficile GDH;
determining that the patient has a low subclinical quantity of C. difficile indicating a carrier status when the fecal sample has the low level of C. difficile GDH, and withholding antibiotic treatment from the patient determined to have the low subclinical quantity of C. difficile indicating the carrier status; and
determining that the patient has active C. difficile disease when the fecal sample has the high level of C. difficile GDH, and treating the patient determined to have active C. difficile disease with antibiotics.
2. The method of claim 1 , further comprising determining a level of toxin A or toxin B in the fecal sample.
3. The method of claim 1 , further comprising determining a level of lactoferrin in the fecal sample to identify patients with intestinal inflammation.
4. The method of claim 1 , further comprising determining a level of one or more other antigens in the fecal sample, wherein the one or more other antigens are quantitatively measured.
5. The method of claim 1 , further comprising contacting the fecal sample with immobilized polyclonal or monoclonal antibodies to C. difficile GDH to create an antibody bound sample.
6. The method of claim 5 , further comprising contacting the antibody bound sample with enzyme-linked polyclonal or monoclonal antibodies such that the enzyme-linked polyclonal or monoclonal antibodies are allowed to bind to capture C. difficile GDH and create an enzyme-linked antibody bound sample.
7. The method of claim 6 , further comprising adding a substrate to the enzyme-linked antibody bound sample for color development to create a readable enzyme-linked antibody bound sample.
8. The method of claim 7 , further comprising determining an optical density of said readable enzyme-linked antibody bound sample using a wavelength, wherein the optical density corresponds to a level of C. difficile GDH in the readable enzyme-linked antibody bound sample.
9. The method of claim 8 , wherein if said optical density of said readable enzyme-linked antibody bound sample is positive, said fecal sample contains the high level of C. difficile GDH.
10. The method of claim 1 , further comprising determining a presence of toxin A or toxin B in the fecal sample, and determining a level of lactoferrin in the fecal sample.
11. The method of claim 10 , wherein the withholding antibiotic treatment from the patient determined to have the low subclinical quantity of C. difficile indicating the carrier status comprises withholding antibiotic treatment from the patient when the fecal sample has the low subclinical quantity of C. difficile , and the level of lactoferrin in the fecal sample is about 7.25 μg/ng or less, and no toxin A or toxin B is present in the fecal sample.
12. The method of claim 10 , wherein the determining that the patient has active C. difficile disease when the fecal sample has the high level of C. difficile GDH comprises determining that the patient has active C. difficile disease when the fecal sample has the high level of C. difficile GDH, the level of lactoferrin in the fecal sample is greater than 7.25 μg/ng, and toxin A or toxin B is present in the fecal sample.