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Comparison of clinical, microbiologic, and clinicopathologic findings in horses positive and negative for Clostridium difficile infection

Rebecca RubyDepartment of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA 95616.

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K. Gary MagdesianDepartment of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA 95616.

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Philip H. KassDepartment of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, CA 95616.

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Abstract

Objective—To compare clinical, microbiologic, and clinicopathologic findings among horses infected with Clostridium difficile that had toxin A in their feces, horses with evidence of C difficile infection that were negative for toxin A in their feces, and horses with diarrhea that were negative for C difficile infection.

Design—Cross-sectional study.

Animals—292 horses and foals with diarrhea.

Procedures—Feces were submitted for microbial culture and tested for the C difficile antigen glutamate dehydrogenase and for toxin A with a commercial ELISA.

Results—Horses with toxin A in their feces had higher band neutrophil count, rectal temperature, hospitalization time prior to the onset of diarrhea, and total hospitalization time than did horses without evidence of C difficile infection, and 32 of the 33 (97%) horses with toxin A in their feces had received antimicrobials prior to the onset of diarrhea. Horses with toxin A in their feces had a significantly higher mortality rate than did horses negative for toxin A in their feces. Sensitivity and specificity of the ELISA for detection of C difficile antigen were 93% and 88%, when assay results were compared with results of microbial culture following direct plating, and 66% and 93%, when assay results were compared with results of microbial culture following broth enrichment.

Conclusions and Clinical Relevance—Results provided some evidence that horses positive for toxin A had more severe clinical disease than did horses with evidence of C difficile infection that were negative for toxin A and horses with diarrhea without evidence of C difficile infection.

Abstract

Objective—To compare clinical, microbiologic, and clinicopathologic findings among horses infected with Clostridium difficile that had toxin A in their feces, horses with evidence of C difficile infection that were negative for toxin A in their feces, and horses with diarrhea that were negative for C difficile infection.

Design—Cross-sectional study.

Animals—292 horses and foals with diarrhea.

Procedures—Feces were submitted for microbial culture and tested for the C difficile antigen glutamate dehydrogenase and for toxin A with a commercial ELISA.

Results—Horses with toxin A in their feces had higher band neutrophil count, rectal temperature, hospitalization time prior to the onset of diarrhea, and total hospitalization time than did horses without evidence of C difficile infection, and 32 of the 33 (97%) horses with toxin A in their feces had received antimicrobials prior to the onset of diarrhea. Horses with toxin A in their feces had a significantly higher mortality rate than did horses negative for toxin A in their feces. Sensitivity and specificity of the ELISA for detection of C difficile antigen were 93% and 88%, when assay results were compared with results of microbial culture following direct plating, and 66% and 93%, when assay results were compared with results of microbial culture following broth enrichment.

Conclusions and Clinical Relevance—Results provided some evidence that horses positive for toxin A had more severe clinical disease than did horses with evidence of C difficile infection that were negative for toxin A and horses with diarrhea without evidence of C difficile infection.

Contributor Notes

Supported by the Center for Equine Health, with funds from the Oak Tree Racing Association, the State of California pari-mutuel wagering fund, and contributions from private donors.

Address correspondence to Dr. Magdesian.