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Tests and diagnosis

By Mayo Clinic staff

Doctors often suspect C. difficile in anyone with diarrhea who has recently taken antibiotics or when diarrhea develops a few days after hospitalization. In such cases, you're likely to have one or more of the following tests.

Stool tests
Toxins produced by C. difficile bacteria can usually be detected in a sample of your stool. Several main types of lab tests exist, and they include:

  • Enzyme immunoassay. Most labs use the enzyme immunoassay (EIA) test, which is faster than other tests, but isn't sensitive enough to detect many infections and has a higher rate of falsely normal tests.
  • Polymerase chain reaction. This sensitive molecular test can rapidly detect the C. difficile toxin B gene in a stool sample and is highly accurate. It's now being adapted by several laboratories and becoming more widely available.
  • Cell cytotoxicity assay. A cytotoxicity test looks for the effects of the C. difficile toxin on human cells grown in a culture. This type of test is sensitive, but it is less widely available, more cumbersome to do and requires more than 24 to 48 hours for test results. Some hospitals use both the EIA test and cell cytotoxicity assay to ensure accurate results.

Testing for C. difficile is unnecessary if you're not having diarrhea or watery stools.

Colon examination
In rare instances, to help confirm a diagnosis of C. difficile infection, your doctor may examine the inside of your colon. This test (flexible sigmoidoscopy or colonoscopy) involves inserting a flexible tube with a small camera on one end into your colon to look for areas of inflammation and pseudomembranes.

Imaging tests
If your doctor is concerned about possible complications of C. difficile, he or she may order an abdominal X-ray or a computerized tomography (CT) scan, which provides images of your colon. The scan can detect the presence of complications such as thickening of the colon wall, expanding of the bowel, or more rarely, a hole (perforation) in the lining of your colon.

Treatments and drugs Complications
References
  1. Khanna S, et al. Clostridium difficile infection: New insights into treatment. Mayo Clinic Proceedings. 2012;87:1106.
  2. Rebmann T, et al. Preventing Clostridium difficile infections: An executive summary of the Association for Professionals in Infection Control and Epidemiology's elimination guide. American Journal of Infection Control. 2011;39:239.
  3. LaMont JT. Clostridium difficile in adults: Epidemiology, microbiology, and pathophysiology. http://www.uptodate.com/home. Accessed March 25, 2013.
  4. Kelly CP, et al. Clostridium difficile in adults: Treatment. http://www.uptodate.com/home. Accessed March 25, 2013.
  5. Frequently asked questions about Clostridium difficile for healthcare providers. Centers for Disease Control and Prevention. http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_faqs_HCP.html. Accessed March 25, 2013.
  6. Headley CM. Deadly diarrhea: Clostridium difficile infection. Nephrology Nursing Journal. 2012;30:459.
  7. LaMont JT. Clostridium difficile in adults: Clinical manifestations and diagnosis. http://www.uptodate.com/home. Accessed March 25, 2013.
  8. Surawicz CM, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. The American Journal of Gastroenterology. In press. Accessed March 25, 2013.
  9. Armstrong GD, et al. A potential new tool for managing Clostridium difficile infection. The Journal of Infectious Diseases. In press. Accessed March 25, 2013.
  10. Venugopal AA, et al. Current state of Clostridium difficile treatment options. Clinical Infectious Diseases. 2012;55:S71.
  11. Vancomycin hydrochloride. Micromedex Healthcare Series. http://www.micromedex.com. Accessed March 27, 2013.
  12. Fidaxomicin. Micromedex Healthcare Series. http://www.micromedex.com. Accessed March 27, 2013.
  13. Van Nood E, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. New England Journal of Medicine. 2013;368:407.
  14. Diarrhea. National Digestive Diseases Information Clearinghouse. http://digestive.niddk.nih.gov/ddiseases/pubs/diarrhea/#treated. Accessed March 27, 2013.
  15. Clostridium difficile and C. difficile toxin testing. Lab Tests Online. http://labtestsonline.org/understanding/analytes/cdiff/tab/test. Accessed April 15, 2013.
  16. Public workshop: Fecal microbiota for transplantation. U.S. Food and Drug Administration. http://www.fda.gov/BiologicsBloodVaccines/NewsEvents/WorkshopsMeetingsConferences/ucm341643.htm. Accessed April 15, 2013.
  17. Steckelberg JM (expert opinion). Mayo Clinic, Rochester, Minn. April 16, 2013.
  18. Khanna S, et al. The epidemiology of community-acquired Clostridium difficile infection: A population-based study. The American Journal of Gastroenterology. 2012;107: 89.
  19. Khanna S (expert opinion). Mayo Clinic, Rochester, Minn. April 17, 2013.
DS00736 July 16, 2013

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