Usefulness of Simultaneous Detection of Toxin A and Glutamate Dehydrogenase for the Diagnosis of Clostridium Difficile-Associated Diseases

Eur J Clin Microbiol Infect Dis. 2000 Jun;19(6):481-4. doi: 10.1007/s100960000297.


The aim of this study was to evaluate an immunoassay (Triage; Biosite Diagnostics, BMD, France) for detecting both a specific antigen of Clostridium difficile (glutamate dehydrogenase [GDH]) and toxin A. Evaluation of the test was carried out in 304 fecal samples from patients suspected of having Clostridium difficile-associated diseases. The results with GDH and toxin A were compared with those of a culture and cytotoxicity assay (toxin B). The prevalence rates for toxin B-positive and culture-positive fecal samples were 11.2% and 25%, respectively. The sensitivity of the Triage immunoassay was 90.8% for GDH and 79.4% for toxin A. A negative result with both toxin A and GDH was very reliably able to eliminate a diagnosis of Clostridium difficile-associated disease (negative predictive value 99.6%). Triage is a very rapid (20 min) and easy-to-perform test. It could be useful for diagnostic purposes and also for detecting nontoxigenic strains in epidemiogical studies.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Bacterial Proteins*
  • Bacterial Toxins / analysis*
  • Bacterial Toxins / immunology
  • Clostridium Infections / diagnosis*
  • Clostridium difficile / isolation & purification*
  • Enterocolitis, Pseudomembranous / diagnosis*
  • Enterotoxins / analysis*
  • Enterotoxins / immunology
  • Feces / microbiology
  • Glutamate Dehydrogenase / analysis*
  • Glutamate Dehydrogenase / immunology
  • Humans
  • Immunoassay / methods*
  • Predictive Value of Tests
  • Reproducibility of Results
  • Sensitivity and Specificity


  • Bacterial Proteins
  • Bacterial Toxins
  • Enterotoxins
  • tcdA protein, Clostridium difficile
  • toxB protein, Clostridium difficile
  • Glutamate Dehydrogenase