Fecal ELISA for C. perfringens enterotoxin

Sample submission

For these tests we will require up to 1 gram of fresh feces. Samples should be refrigerated shortly after collection and shipped overnight cooled withice packs (please contact us concerning our shipping program).

Clostridium perfringens-associated diarrhea

Clostridium perfringens, a gram-positive, anaerobic, spore-forming rod, has been associated with bacterial diarrhea in both dogs and cats. One of the main virulence factors believed to be associated with C. perfringens-associated diarrhea is the C. perfringens enterotoxin (CPE), which is encoded by the cpe gene. CPE, produced during sporulation and released after cell lysis, has been shown to induce mucosal damage, increase intestinal permeability, and reduce water absorption, thus leading to diarrhea.

In general, any dog or cat with small and/or large bowel diarrhea may have C. perfringens-associated diarrhea. The diarrhea may or may not be accompanied by the presence of mucus, blood, and/or tenesmus, and it can be acute or chronic. The disease might range from mild and self-limiting to severe. Systemic signs are uncommon. C. perfringens is considered to be a major cause of nosocomial diarrhea, which often occurs a few days after admission of a patient to a veterinary hospital. Due to the non-specific clinical signs associated with C. perfringens-diarrhea, any dog or cat with diarrhea could be tested for this disease.

Bacterial culture for the isolation of C. perfringens has little diagnostic value, as C. perfringens is a commensal organism that can be detected in up to 100% of the feces from dogs and cats. Microscopic examination of fecal smears and enumeration of fecal endospores also is not useful for the diagnosis of C. perfringens-associated diarrhea, because sporulation of these organisms occurs in both healthy and diarrheic animals. The development of C. perfringens-associated diarrhea has primarily been related to the presence of various toxins, especially C. perfringens enterotoxin (CPE). Only a subset of C. perfringens organisms carries the gene coding for CPE. When sporulation occurs, which is induced by conditions that are not well understood (suspected triggers include dietary changes or antibiotic use), the enterotoxin is released in high quantities and may potentially cause changes in intestinal permeability, leading to diarrhea.

Enterotoxigenic C. perfringens can be detected using PCR assays that target the CPE gene. However, recent studies have shown that approximately 20% of healthy cats, 37% of healthy dogs, and 37% of diarrheic dogs and cats harbor the CPE gene. Similar results with no significant differences in prevalence rates of enterotoxigenic C. perfringens between healthy and diarrheic dogs have been observed in other studies. Furthermore, in only a small percentage of animals that harbor enterotoxigenic C. perfringens, the expressed enterotoxin can be detected in the feces. Therefore, the use of PCR for the detection of the cpe gene of enterotoxigenic C. perfringens appears to have limited utility for the diagnosis of C. perfringens-associated diarrhea.

We therefore recommend to evaluate fecal samples for C. perfringens enterotoxin by ELISA in patients that are suspected of having C. perfringens-associated diarrhea.