A RAPID TEST FOR INFECTIOUS AND INFLAMMATORY ENTERITIS

Background: Inflammatory illnesses are an indication for specific diag nostic studies and possible antimicrobial therapy. The presence of fec al leukocytes has been used as a marker of inflammatory diarrhea; howe ver, microscopic examination of the fecal smear is unreliable if the s pecimen is transported, refrigerated, frozen, or collected by swab. Ob jective: To evaluate a rapid, sensitive, semiquantitative test for det ection of fecal leukocytes using antilactoferrin latex bead agglutinat ion (LFLA), a test that remains sensitive even after specimens are ref rigerated, frozen, or stored on swabs. Methods: LFLA titers were deter mined in stool specimens from previously healthy volunteers before and after experimental infection with different enteric pathogens and fro m patients with nosocomial diarrhea caused by Clostridium difficile. R esults: Healthy controls and subjects with noninflammatory diarrhea ca used by Vibrio cholerae consistently dem- onstrated LFLA titers less t han 1:50. In contrast, subjects with inflammatory diarrhea caused by S higella species and C difficile had markedly elevated titers. Titers f or subjects with experimental shigellosis ranged from 1:50 to 1:3200, with seven (78%) of nine at 1:400 or greater. Titers for patients with C difficile enteritis ranged as high as 1:1200, with six (50%) of 12 at 1:400 or greater. Subjects with experimental enteropathogenic Esche richia coil infection also had elevated titers, ranging from 1:100 to 1:1600, with three (43%) of seven at 1:400 or greater. Titers for subj ects with experimental enterotoxigenic E coil infection were moderatel y elevated, with nine (53%) of 17 ranging from 1:50 to 1:200 (only one [6%] of 17 was greater than or equal to:400), suggesting a mild infla mmatory process. Conclusions: The fecal LFLA assay distinguishes infla mmatory from noninflammatory diarrhea, may provide new information on mildly inflammatory processes, and may be a useful, rapid test in a di agnostic algorithm for acute, infectious diarrheal illnesses.