CULTURE OR NOT TO CULTURE - FECAL LACTOFERRIN SCREENING FOR INFLAMMATORY BACTERIAL DIARRHEA

Because of its low yield in unselected specimens, stool culture is oft en cost ineffective. We tested 55 fecal samples from Fairfax Hospital (46 from patients with diarrhea and 9 from controls without diarrhea) for lactoferrin by latex agglutination (LFLA) with the Leukotest (Tech lab, Blacksburg, Va.) as a marker for inflammatory diarrhea. Of the 28 samples with Salmonella, Shigella, or Campylobacter infection, 93% ha d detectable fecal lactoferrin at greater than or equal to 1:50 (61% h ad LFLA titers of greater than or equal to 1:400). A while 83% of 18 s amples with rotavirus or no detectable pathogen were LFLA negative at a titer of 1:50 (100% were negative at 1:400). All 9 controls without diarrhea were LFLA negative at 1:50. The use of fecal lactoferrin to s creen for inflammatory diarrhea selects specimens for which stool cult ure is fivefold more likely to yield an invasive bacterial pathogen (r educing the cost per positive result by over $800) and thus may greatl y enhance a cost-effective approach to evaluating diarrheal illness.