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C Difficile DNA positive (urgent)

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Posted 5/29/2014 5:43 PM (GMT 0)
We had checked for C Diff for my daughter about 5 times before and it always came negative.She has had 3 flares in last 6 mths and each time when they give Predinisone at 21mg her flare stops and her flare returns back when her prednisone is lowered to 5 mg.

Before her colitis symptoms started, she was given a course of Augmentin for about 1 week. I always suspected that her colitis must have been antibiotic related and her GI said it is not possible as she always comes negative for C Diff and responds to Prednisone. According to her GI, if my daughter has C Diff then she will not respond to Prednisone and her stools will stink a lot. In her case, she always responded to Prednisone and her stools never stinked. Each time her C Diff test was done her stools were very watery.

2 weeks back, she got another flare and we wanted to give an attempt with Ayurveda before switching to 6MP. So, I went to her regular pediatrician and not her GI and her pediatrician ordered a fresh set of tests for Ova and Parasites,C Diff DNA, C Diff toxin B gene.

Her results came back as follows.

C Difficule DNA detected
C Diff Toxin B Gene not detected.

What does C Difficule DNA mean ? I see multiple tests for C Diff in Quest Diagnostics.



Please advice me ASAP.

Post Edited (kamakya) : 5/29/2014 1:47:14 PM (GMT-6)

Posted 5/29/2014 5:56 PM (GMT 0)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC149705/

http://www.meridianbioscience.com/disease-information/c-difficile/testing.aspx
Posted 5/29/2014 6:01 PM (GMT 0)
what did her doctor say?? i'm not sure what the two c diffs means either. i only have one result when my c diff test comes back- positive or negative.

i do agree with your gi doc though. she would not respond to pred if c diff has been her problem all along.
Posted 5/29/2014 6:03 PM (GMT 0)
@kazbern. Tx a lot. Does "C Difficule DNA detected" mean my daughter is positive for C Diff. I tried to call her GI for appointment as this is a new finding but the soonest that I may get is next week.


Her current symptoms
=================

1> Diarrhea with blood about 5-6 times a day
2> Stool does not smell ( I read C Diff stool will stink a lot)
3> She responds to Prednisone when her Pred level is high and flare returns when Pred is tapered less than 9MG
Posted 5/29/2014 6:04 PM (GMT 0)
did you read the articles I linked? I hope the ped calls back soon. Didn't you guys do a fecal transplant?
Posted 5/29/2014 6:09 PM (GMT 0)
@kazbern: We have not done Fecal transplant yet as FT was supposed to be good for C Diff and not regular UC.So far her diagnosis was that she has UC and not C Diff. I had asked her pediatrician to give an order form for C Diff as her GI did not want to repeat C Diff as it had come negative multiple times before.

Her pediatrician based on my request, ordered the following test from Qust Diagnostics.

Clostridium difficile DNA and Toxin B Gene, Qualitative, Real-Time PCR

http://www.questdiagnostics.com/testcenter/TestDetail.action?tabName=OrderingInfo&ntc=16739

Clinical Significance
Clostridium difficile strains producing toxin A and/or toxin B are associated with diarrheal disease, whereas strains that produce neither toxin are not. Most C. difficile strains associated with diarrheal disease produce both toxin A and B. Thus, this qualitative Real-Time PCR assay is useful for the diagnosis of toxigenic C. difficile associated with diarrheal disease.

Post Edited (kamakya) : 5/29/2014 12:22:58 PM (GMT-6)
Posted 5/29/2014 10:13 PM (GMT 0)
Antibiotic use can be associated with both C-Diff and UC. I don't think there is a definitive proof that antibiotics cause UC but there is much circumstantial evidence. I'm pretty sure my UC is due to the use of a broad spectrum antibiotic.
Posted 5/29/2014 11:21 PM (GMT 0)
C diff DNA means that there is C diff, living or dead, in the sample. If a person who had recovered from Strep throat were tested for S. pyogenes, they would be showing positive for the DNA even if the bacteria were dead ie.no longer causing infection.

Many people carry C diff without ever getting ill from it. Those people will be positive for C diff DNA even though it's not causing active infection.

The toxin is what indicates ACTIVE, LIVE bacteria.
Posted 5/30/2014 12:17 AM (GMT 0)
@geeker : My daughter is having a flare now. Does this mean it is caused by her UC or by C Diff? The reason why I'm asking is that my GI has been pushing us for 6MP and we are currently on Lialda. If it is C Diff, then I can ask her to Fecal transplant instead of moving to 6MP and continue to stay on Lialda. Today's C Diff result has been very confusing for me.
Posted 5/30/2014 12:28 AM (GMT 0)
Did they test the Toxin B GENE or for the toxin itself? Need more info. You typed "gene" and I just want to verify that is exactly accurate.

The presence of the C diff DNA alone does not indicate that the flare symptoms are being caused by C diff.
Posted 5/30/2014 12:38 AM (GMT 0)
It says

C Difficile DNA Detected
Toxin B Gene Not detected


Does C Difficile DNA mean that C Diff was there sometime back (even though undetected). Will my daughter be a good candidate for Fecal transplant? I'm trying my best to avoid going from 5ASA to 6MP.
Posted 5/30/2014 12:43 AM (GMT 0)
Here you go...look down the left flowchart.

When I was diagnosed with C diff both were positive.

This is not an end-all-be-all reference, just what I have seen before at work.

http://www.arupconsult.com/Algorithms/CDAD.pdf
Posted 5/30/2014 12:55 AM (GMT 0)
@geeker. It was very helpful. But it does not say anything about C Difficile DNA.
Posted 5/30/2014 12:58 AM (GMT 0)
Clostridium will or really should be detected in pretty much everyone. It's a commensal bacteria - and a very beneficial one.

The "gene" part just means that the Clostridium strain carries the gene (i.e. the genetic ability or blueprint) that enables them to produce in this particular test case Toxin B - which was negative.

The results based on what you typed are saying Clostridium Species is detected in the stool sample but they lack the gene for toxin production... so it's a negative result.

That's all...

Hope that helps.

EDIT: I guess I should say certain strains of Clostridium seem to be very beneficial (i.e. Butyrate production etc etc )

EDIT - Sorry and the DNA part is the read for Clostridium Difficile or Clostridium in general depending on the test and gene part is the ability to produce toxin B - again negative in this case.

Post Edited (Canada Mark) : 5/29/2014 7:04:47 PM (GMT-6)

Posted 5/30/2014 1:17 AM (GMT 0)
@Canada Mark : Based on your feedback, I should consider this as C Diff negative and the original diagnosis of UC still holds good.
Posted 5/30/2014 1:21 AM (GMT 0)
I thought I had explained the detection of the DNA in my first post, and how it does not mean infection.
The tcdB gene test is what I was pointing out in the chart.

Chart states that *toxigenic C diff not detected*.
Posted 5/30/2014 1:22 AM (GMT 0)
I think Mark is correct. Everyone seems to have concentrations of c. diff (and more so in children), but those who are not immune compromised are able to keep it in check. Antibiotics will more or less destroy this balance and increase the risk of it significantly.
Posted 5/30/2014 1:59 PM (GMT 0)
Yes negative... for Toxin producing C-diff. Or B toxin producing really. Do bring it up with your GI or primary care physician even just on the phone though to be 100% sure.
Posted 5/30/2014 5:20 PM (GMT 0)
@canadamark :I will follow up with my GI next week. Do I have to test Toxin Gene A too? That was the earliest appointment that I got. Her pediatrician seems confused and does not really know if C Diff is there are not. Initially, she said my DD has C Diff and then when I explained what you guys told on forum, she said it is true and asked me to follow up with my GI.

I got more test results today.

Test Name : Clostridium difficile culture w/Reflex to Toxin

Clostridium difficile culture

ORGANISM(S) ISOLATED 1. Clostridium difficile
******PRIORITY 2 RESULT VALUE ***********************

Post Edited (kamakya) : 5/30/2014 11:37:14 AM (GMT-6)

Posted 6/5/2014 4:25 AM (GMT 0)
Any update?

Take a look at powerofpoop . com for FMT donor.
Posted 6/5/2014 7:28 PM (GMT 0)
I got another stool test today and it says

Organisms isolated: Source of culture Stool
1>Klebsiella Pneumoniae - Moderate growth

I have an appointment with my GI tomorrow and want to discuss about Klebsiella. Can this cause colitis? It was never seen in previous stoool tests.
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