Evaluation of real time polymerase chain reaction and enzyme immunoassay in diagnosis of clostridium difficile infection

Background: Clostridium difficile infection [CDI] is the most common cause of antibiotic associated diarrhea [AAD]. Rapid diagnosis of CDI is essential to prevent hospital spread of infection

Objectives: The aim of this work were to determine the prevalence of CDI among cases of AAD in Zagazig University Hospitals, identify risk factors, and evaluate real-time polymerase chain reaction [PCR] and enzyme immunoassay [EIA], against toxigenic culture [TC]

Methodology: Stools were collected from 150 patients with AAD

Results: They were tested for TC, toxin A/B EIA, and C. difficile tcdA/tcdB genes. Thirty four toxigenic C. difficile isolates were obtained [22.7%] out of the 150 patients and those patients were considered positive for CDI. On the other hand, 6 non-toxigenic C. difficile isolates were obtained [4%], while culture of the remaining 110 patients [73.3%] did not yield C. difficile. The later 116 patients [77.3%] were considered negative for CDI. Analysis of risk factors revealed that advanced age, prolonged hospitalization, long duration of antibiotic intake, potentiated penicillins, 3rd generation cephalosporins, antibiotic combined therapy, liver cirrhosis, malignancy, proton pump inhibitors, enteral tube feeding, and cancer chemotherapy were significantly associated with CDI. Sensitivitiy, specificitiy, positive predictive value, negative predictive value, and accuracy of real-time PCR against TC were all 100%, however, values of EIA were 79.4%, 100%, 100%, 94.3%, 95.3%, respectively

Conclusions: CDI is an underappreciated nosocomial infection predisposed by many risk factors. Real-time PCR proved superior diagnostic performance to toxin A/B EIA

Immune response in bilharzial farmers [uncomplicated and complicated cases]

This study was done in the Outpatient Clinic of Zagazig University Hospital and in the Bacteriology Department of Zagazig University during the year 1991. The aim was to evaluate the immune response [humoral and cellular] of bilharzial patients in various stages of infection through quantitation of specific antibodies using indirect hemagglutination test [IHAT] and quantitation of sensitized T- lymphocytes and their subpopulations using indirect immunofluorescent technique. The study included 25 normal healthy individuals, 25 simple urinary bilharziasis, 25 simple intestinal bilharziasis, and 25 hepatosplenic patients. There was a marked increase in the mean titer of IHAT of bilharzial groups compared with normal controls, but there was no significant statistical difference among the bilharzial groups. The study revealed a decrease in the means of total leucocytic count [TLC], absolute lymphocytic count [ALC], T3+ count, T4+ count and T4+/T8+ ratio of bilharzial groups. Comparable with the normal cases, T8+ counts of bilharzial groups were within normal. There were highly statistically significant lower mean values of total leucocytic count [TLC], T4+ counts, and T4+/T8+ ratio of complicated intestinal [hepatosplenic] group comparable with simple bilharzial groups