Abstract
Background Clostridium difficile infection (CDI) is one of the most dreaded causes of hospital-acquired diarrhea. Main objective was to investigate whether confocal laser endomicroscopy (CLE) has the capability for in vivo diagnosis of C. difficile associated histological changes. Second objective was to prove the presence of intramucosal bacteria using CLE.Methods80 patients were prospectively included, 10 patients were diagnosed with CDI based on toxigenic culture. To validate the presence of intramucosal bacteria ex vivo, CLE was performed in pure C. difficile culture; additionally fluorescence in situ hybridization (FISH) was performed. Finally, CLE with fluorescence labelled oligonucleotide probe specific for C. difficile was performed ex vivo in order to prove the presence of bacteria.ResultsCLE identified CDI-associated histological changes in vivo (sensitivity and accuracy of 88.9% and 96.3%). In addition, intramucosal bacteria were visualized. The presence of these bacteria could be proven by CLE with labeled, specific molecular C. difficile probe and FISH-technique. Based on comparison between CLE and FISH analyses, sensitivity and specificity for the presence of intramucosal bacteria were 100%.ConclusionCLE has the potential for in vivo diagnosis of CDI associated colitis. In addition, CLE allowed the detection of intramucosal bacteria in vivo.
Highlights
Clostridium difficile infection has emerged as one of the most clinically significant causes of hospital-acquired diarrhea and is associated with significant morbidity and mortality
C. difficile can colonize the large bowel and, in the presence of antibiotic therapy that limits the growth of naturally residing microorganisms, produce endotoxins and cytotoxins that can cause severe mucosal damage, resulting in colitis that may have a pseudomembranous appearance at endoscopy [1]
It has been estimated that C. difficile causes approximately 25% of the antibiotic-associated diarrhea (AAD) and most cases of pseudomembranous colitis
Summary
Clostridium difficile infection has emerged as one of the most clinically significant causes of hospital-acquired diarrhea and is associated with significant morbidity and mortality. C. difficile can colonize the large bowel and, in the presence of antibiotic therapy that limits the growth of naturally residing microorganisms, produce endotoxins and cytotoxins that can cause severe mucosal damage, resulting in colitis that may have a pseudomembranous appearance at endoscopy [1]. It has been estimated that C. difficile causes approximately 25% of the antibiotic-associated diarrhea (AAD) and most cases of pseudomembranous colitis. In the United States, there are about 300,000 cases of C. difficile-associated diarrhea and colitis per year, resulting in an annual economic burden of more than one billion dollars to the health care system [2]. Clostridium difficile infection (CDI) is one of the most dreaded causes of hospital-acquired diarrhea. Second objective was to prove the presence of intramucosal bacteria using CLE
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