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Very occasionally, a patient with ileus and complicated disease will have a formed stool (3), in which case the laboratory should be made aware of this special clinical situation.
Rectal swabs can be used for PCR and thus may be useful in timely diagnosis of patients with ileus (15). However, EIA tests have substantially reduced sensitivities compared with reference standards.
Moreover, toxin A immunoassays (without toxin B) miss detecting the small number of pathogenic strains that only produce toxin B (10,19). Two major advances in the laboratory diagnosis are the use of GDH detection in stools as a means of screening for CDI and the development of NAATs such as PCR to detect toxigenic strains of C.