Official reprint from UpToDate®
www.uptodate.com ©2018 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Medline ® Abstract for Reference 26

of 'Clostridium difficile infection in adults: Clinical manifestations and diagnosis'

Protein-losing enteropathy associated with Clostridium difficile infection.
Rybolt AH, Bennett RG, Laughon BE, Thomas DR, Greenough WB 3rd, Bartlett JG
Lancet. 1989;1(8651):1353.
A commercially available radial immunodiffusion assay was used to measure serum alpha-1-antitrypsin levels in stool samples from subjects aged over 60 years as a marker of protein-losing enteropathy. alpha 1-antitrypsin was found in all of 12 patients with colonoscopy-confirmed pseudomembranous colitis, 6 of 14 (43%) patients with Clostridium difficile diarrhoea without pseudomembranes, 6 of 12 (50%) nursing-home patients culture-positive for Cl difficile but negative for its cytotoxin, and none of 15 healthy control subjects. It is concluded that serum protein loss into the gastrointestinal tract can occur as a result of Cl difficile infection, that its presence correlates with the severity of disease, and that it may occur even in the absence of diarrhoea. The diagnosis of protein-losing enteropathy should be considered for all patients with Cl difficile infection, particularly elderly nursing-home patients, in whom the risk of Cl difficile disease and the frequency of severe malnutrition are high.
Division of Geriatric Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Chronic Hospital and Nursing Home, Baltimore, Maryland.