Background & Objective: Immune defense cells such as polymorphonuclear (PMN) leucocytes and monocytes are present in the colonic mucosa and aid in local inflammatory response. Myeloperoxidase (MPO) abundantly present in immune defense cells gets released upon neutrophil activation. Clostridium difficile is an anaerobic bacteriumresponsible for nosocomial diarrhea and severe colitis.
Methods: A retrospective study was undertaken to quantify the presence of colonic inflammation by evaluation of fecal MPO activity as an adjunct to C. difficile diarrhea. A total of 560 patients with nosocomial diarrhea and 123 healthy subjects with no diarrhea formed the basis of our investigation. C. difficile was investigated either by stool culture (n=351) or by C. difficile toxin (CDT) assay (n=209) using purified anti-toxin A and anti-toxin B. MPO activitywas measured using dianisidine hydrogen peroxidase.
Results: MPO was positive in 76.8% of patient samples. Chi square test for MPO analysis showed that it was significantly distributed over positive and negative values. A total of 115 stool cultures were positive for various organisms, of which 91 were also MPO positive. There were 38 C. difficile culture positive of which 34 were also MPO positive. MPO activity in relation to CDT assay showed that 43% were positive for both CDT and MPO. When control samples were analyzed, MPO was positive in 11.7% with C. difficile growing in 4/30 (13%) of the cultured samples. CDT was negative in the remaining control samples.
Interpretation and Conclusion: High levels of MPO may signal the acuity of the disease and indicate inflammation. Fecal MPO is a simple, inexpensive and objective tool for assessing the degree of acute inflammation in the intestine.
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