SMALL INTESTINE

A novel method for rapidly diagnosing the causes of diarrhoea

C S J Probert¹, P R H Jones², N M Ratcliffe²

¹ Department of Medicine, Bristol Royal Infirmary, Bristol, UK
² Faculty of Applied Sciences, Centre for Research in Analytical, Materials, and Sensor Sciences, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, UK

Correspondence to:
Correspondence to:
Dr C S J Probert
Department of Medicine, Bristol Royal Infirmary, Marlborough St, Bristol BS2 8HW, UK; c.s.j.probert{at}bristol.ac.uk

Background: The microbiological diagnosis of infectious diarrhoea may take several days using conventional techniques. In order to determine whether flatus can be used to make a rapid diagnosis, the volatile organic compounds associated with diarrhoea were analysed.

Methods: Stool samples were collected from 35 patients with infectious diarrhoea and from six healthy controls. Gaseous compounds were extracted from a headspace using solid phase microextraction and analysed using gas chromatography and mass spectroscopy.

Results: Characteristic patterns of volatile gases were found for the main causes of infectious diarrhoea in hospitals. Furan species without indoles indicated Clostridium difficile, ethyl dodecanoate indicated rotavirus, ammonia without ethyl dodecanoate suggested other enteric viruses, and the absence of hydrocarbons and terpenes indicated Campylobacter infection.

Conclusion: These results could be the basis of rapid near patient diagnosis of infectious diarrhoea.

Keywords: gas chromatography; mass spectroscopy; gastroenteritis; Clostridium difficile; rotavirus; Norwalk virus; Campylobacter

Abbreviations: ELISA, enzyme linked immunosorbent assay; VOCs, volatile organic compounds; SRSV, small rounded structured virus; BMT, bone marrow transplantation; SPME, solid phase microextraction; GC, gas chromatography; MS, mass spectroscopy; PPV, positive predictive value; NPV, negative predictive value

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