PMID- 36855500
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230302
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 1
DP  - 2023 Jan
TI  - A Review on Clostridioides Difficile Testing and How to Approach Patients With 
      Multiple Negative Tests: A Case Report.
PG  - e34285
LID - 10.7759/cureus.34285 [doi]
LID - e34285
AB  - Clostridioides difficile (C. difficile) is an important nosocomial infection that 
      is commonly associated with antibiotic use with pseudomembranous colitis being 
      present in only 13% of cases. Disease severity ranges from asymptomatic carriers 
      to severe complicated disease, based on clinical and laboratory findings. There 
      is no single rapid FDA-approved test to diagnose C. difficile infections (CDI) 
      and diagnosis usually requires a multi-step diagnostic approach. C. difficile 
      testing usually begins with the C. difficile toxin and glutamate dehydrogenase 
      antigen screen (GDH). If testing is negative for either, then nucleic acid 
      amplification testing (NAAT) is done to confirm the diagnosis. Endoscopic 
      evaluation may be required in rare instances when there is a high clinical 
      suspicion of disease with negative testing. Here, we present an interesting case 
      of a patient with multiple negative C. difficile toxin and GDH tests. Given the 
      high index of clinical suspicion of CDI, the patient underwent a colonoscopy 
      which revealed diffuse pseudomembranous colitis. The patient was then 
      appropriately treated with oral vancomycin. We aim to shed light on the different 
      testing modalities available to clinicians and the indications for doing a 
      colonoscopy to delineate between false positive testing and active CDI.
CI  - Copyright (c) 2023, Bassi et al.
FAU - Bassi, Raghav
AU  - Bassi R
AD  - Internal Medicine, University of Central Florida College of Medicine, Graduate 
      Medical Education/Hospital Corporation of America (HCA) Florida North Florida 
      Hospital, Gainesville, USA.
FAU - Prakash, Pranav
AU  - Prakash P
AD  - Internal Medicine, University of Central Florida College of Medicine, Graduate 
      Medical Education/Hospital Corporation of America (HCA) Florida North Florida 
      Hospital, Gainesville, USA.
FAU - Oyetoran, Anuoluwa
AU  - Oyetoran A
AD  - Internal Medicine, University of Central Florida College of Medicine, Graduate 
      Medical Education/Hospital Corporation of America (HCA) Florida North Florida 
      Hospital, Gainesville, USA.
FAU - Elsadek, Rabab
AU  - Elsadek R
AD  - Internal Medicine, University of Central Florida College of Medicine, Graduate 
      Medical Education/Hospital Corporation of America (HCA) Florida North Florida 
      Hospital, Gainesville, USA.
FAU - Loseke, Isaac
AU  - Loseke I
AD  - Internal Medicine, University of Central Florida College of Medicine, Graduate 
      Medical Education/Hospital Corporation of America (HCA) Florida North Florida 
      Hospital, Gainesville, USA.
FAU - Leibach, John R
AU  - Leibach JR
AD  - Internal Medicine, University of Central Florida College of Medicine, Graduate 
      Medical Education/Hospital Corporation of America (HCA) Florida North Florida 
      Hospital, Gainesville, USA.
LA  - eng
PT  - Case Reports
DEP - 20230127
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC9968510
OTO - NOTNLM
OT  - c.diff colitis
OT  - c.diff testing
OT  - false-negative
OT  - multiple negative tests
OT  - pseudomembrane
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/03/02 06:00
MHDA- 2023/03/02 06:01
PMCR- 2023/01/27
CRDT- 2023/03/01 02:04
PHST- 2023/01/27 00:00 [accepted]
PHST- 2023/03/01 02:04 [entrez]
PHST- 2023/03/02 06:00 [pubmed]
PHST- 2023/03/02 06:01 [medline]
PHST- 2023/01/27 00:00 [pmc-release]
AID - 10.7759/cureus.34285 [doi]
PST - epublish
SO  - Cureus. 2023 Jan 27;15(1):e34285. doi: 10.7759/cureus.34285. eCollection 2023 
      Jan.