Elevated lactoferrin is associated with moderate to severe Clostridium difficile disease, stool toxin, and 027 infection

• Published in: European journal of clinical microbiology & infectious diseases 2013-12, Vol.32 (12), p.1517-1523
• Main Authors: Boone, J. H., DiPersio, J. R., Tan, M. J., Salstrom, S.-J., Wickham, K. N., Carman, R. J., Totty, H. R., Albert, R. E., Lyerly, D. M.
• Format: Article
• Language: English
• Subjects: Abdomen; Aged; Analysis of Variance; Antibiotics; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Bacterial Toxins - blood; Bacterial Toxins - metabolism; Biological and medical sciences; Biomarkers; Biomarkers - blood; Biomarkers - metabolism; Biomedical and Life Sciences; Biomedicine; Blood; Clostridium difficile - isolation & purification; Clostridium Infections - blood; Clostridium Infections - enzymology; Clostridium Infections - metabolism; Clostridium Infections - microbiology; Epidemics; Feces; Feces - chemistry; Feces - microbiology; Female; Gastroenterology. Liver. Pancreas. Abdomen; Human bacterial diseases; Humans; Infections; Infectious diseases; Inflammation; Inflammatory bowel disease; Internal Medicine; Laboratories; Lactoferrin - blood; Lactoferrin - metabolism; Leukocytes; Male; Medical Microbiology; Medical sciences; Middle Aged; Other diseases. Semiology; Patients; Physicians; Polymerase Chain Reaction; Ribotyping; Serum Albumin - metabolism; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Toxins
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-013-1905-x

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