To the Editor—The recent article by Pollack et al [1] highlights an underappreciated issue related to Clostridium difficile infection (CDI) multistep testing algorithms that include stool toxin testing. While it is acknowledged that negative toxin assays in patients with positive screening tests for C. difficile require clinical evaluation to distinguish asymptomatic carriage from CDI with a negative toxin test, positive toxin assays are generally interpreted as an indicator of CDI requiring treatment [2, 3]. However, asymptomatic carriers of toxigenic C. difficile may also have detectable toxin in stool. Using cell cytotoxicity neutralization assays (CCNA), toxin has been detected in stool...

中文翻译：

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难辨梭状芽孢杆菌无症状携带者粪便中毒素的阳性酶免疫法测定频率

编辑：Pollack等人[1]的最新文章强调了与难辨梭状芽孢杆菌感染（CDI）多步检测算法（包括粪便毒素检测）有关的一个未被充分认识的问题。尽管公认对艰难梭菌筛查试验阳性的患者进行阴性毒素测定需要临床评估，以便将阴性毒素试验将无症状携带与CDI区别开来，但阳性毒素测定通常被解释为需要治疗的CDI指标[2，3 ]。但是，无症状的艰难梭菌载体也可能在粪便中检测到毒素。使用细胞细胞毒性中和测定法（CCNA），已在粪便中检测到毒素。