Background: Inflammatory diarrhoea (ID) resulting from Shigella, Salmonella, Campylobacter and Entamoeba histoly-tica requires specific diagnosis for therapy. Differentiation between ID and non-inflammatory diarrhoea (NID) is often not clinically possible. A faecal occult blood test (FOBT) correlates with faecal leucocytes. Lactoferrin indicates an inflammatory process as a marker for faecal leucocytes. We evaluated diagnostic values of lactoferrin latex aggluti- nation test (LT) either alone or in combination with FOBT, correlating with stool microscopy and microbiology in differentiating ID from NID. Methods: The study population constituted patients enrolled in 2% systematic sampling of patients under Diarrhoeal Disease Surveillance System of Dhaka Hospital, ICDDR,B. Results: Between July and November 2002, 594 patients were enrolled; evaluation of FOBT and LT were done in 448/594 (75%) patients from whom either a single enteropathogen (315/594, 53%) or no pathogen (133/594, 22%) were identified and 146 were excluded for multiple pathogens. Invasive and non-invasive pathogens were isolated from 24% and 76% of the patients. FOBT and LT were positive in 40% and 39% of the samples. The sensitivities, specificities, PPVs, NPVs, and accuracies of FOBT were 55, 63, 24, 87 and 62%, and LT were 52, 64, 23, 86 and 62%, respectively. Conclusion: FOBT and LT are not useful in differentiating ID from NID in diarrhoeal patients in Dhaka, Bangladesh.

Bern C, Martines J, de Zoysa I, Glass RI: The magnitude of the global problem of diarrhoeal disease: a ten-year update. Bull World Health Org 1992;70:705–714.
Guerrant RL, Shields DS, Thorson SM, Schorling JB, Groschel DH: Evaluation and diagnosis of acute infectious diarrhoea. Am J Med 1985;78:91–98.
Guerrant RL, Araujo V, Soares E, Kotloff K, Lima AAM, Cooper WH, et al: Measurement of fecal lactoferrin as a marker of fecal leukocytes. J Clin Microbiol1992;30:1238–1242.
Uchida K, Matsuse R, Tomita S, Sugi K, Saitoh O, Ohshiba S: Immunochemical detection of human lactoferrin in feces as a new marker for inflammatory gastrointestinal disorders and colon cancer. Clin Biochem 1994;27:259–264.
Khan AI, Huq S, Malek MA, Hossain MI, Talukder KA, Faruque ASG, et al: Analysis of fecal leukocytes and erythrocytes in Shigella infections in urban Bangladesh. Southeast Asian J Trop Med Publ Hlth 2006;37:747–754.
Stoll B, Glass R, Banu H, Huq MI, Khan MU, Ahmed M: Value of stool examination in patients with diarrhoea. Br Med J 1983;286:2037–2040.
Hossain MA, Albert MJ: Effect of duration of diarrhoea and predictive values of stool leucocytes and red blood cells in the isolation of different serogroups or serotypes of Shigella. Trans R Soc Trop Med Hyg 1991;85:664–666.
Speelman P, McGlaughlin R, Kabir I, Butler T: Differential clinical features and stool findings in shigellosis and amoebic dysentery. Trans R Soc Trop Med Hyg 1987;81:549–551.
Vogtlin J, Stalder H, Hurzeler L, Vischer W, Loosli J, Gyr K, et al: Modified guaiac test may replace search for faecal leucocytes in acute infectious diarrhea. Lancet 1983;ii: 1204.
Beltinger J, Walther R, Bardhan P, Mahalanabis D, Gyr K: Immunological testing for occult blood in patients with acute infectious diarrhea: can it improve the specificity of the guaiac test? Dig Dis Sci 1997;42:366–371.
Bardhan PK, Beltinger J, Beltinger RW, Hossain A, Mahalanabis D, Gyr K: Screening of patients with acute infectious diarrhoea: evaluation of clinical features, faecal microscopy, and faecal occult blood testing. Scand J Gastroenterol 2000;35:54–60.
Lactoferrin. Arbor Clin Nutr Updates 2006;263:1–3.
Ling JM, et al: Perspectives on interactions between lactoferrin and bacteria. Biochem Cell Biol 2006;84:275–281.
Marshall K: Therapeutic applications of whey protein. Altern Med Rev 2004;9:136–156.
Venkataraman S, Ramakrishna BS, Kang G, Rajan DP, Mathan VI: Faecal lactoferrin as a predictor of positive faecal culture in south Indian children with acute diarrhoea. Ann Trop Paed 2003;23:9–13.
Fried K, Tarkanyi K, Prinz G, Ban E: Detection of lactoferrin in feces for differential diagnosis in diarrhoea. Ort Hetil 2002;143:2141–2144.
Aly SM, El-Zawawy LA, Said DE, Fathy FM, Mohamed ON: The utility of lactoferrin in differentiating parasitic from bacterial infections. J Egypt Soc Parasitol 2005;35:1149–1162.
Bouckenooghe AR, Dupont HL, Jiang ZD, Adachi J, Mathewson JJ, Verenkar MP, et al: Markers of enteric inflammation in enteroaggregative Escherichia coli diarrhea in travellers. Am J Trop Med Hyg 2000;62:711–713.
Stoll BJ, Glass RI, Huq MI, Khan MU, Holt JE, Banu H: Surveillance of patients attending a diarrhoeal disease hospital in Bangladesh. Br Med J1982;285:1185–1188.
Alam NH, Ashraf H: Treatment of infectious diarrhoea in children. Paediatr Drugs 2003;5:151–165.
World Health Organization: Program for Control of Diarrhoeal Diseases. Manual for Laboratory Investigations of Acute Enteric Infections. Geneva, WHO, 1987, pp 15–76, WHO/CDD/83.3 Rev 1.
Faruque SM, Haider K, Albert MJ, Ahmad QS, Alam AN, Nahar S, et al: A comparative study of specific gene probes and standard bioassays to identify diarrhoeagenic Escherichia coli in paediatric patients with diarrhoea in Bangladesh. J Med Microbiol 1992;36:37–40.
Choi SW, Park CH, Silva TMJ, Zaenker EI, Guerrant RL: To culture or not to culture: faecal lactoferrin screening for inflammatory bacterial diarrhea. J Clin Microbiol 1996;34:928–932.
Silletti RP, Lee G, Ailey E: Role of stool screening tests in diagnosis of inflammatory bacterial enteritis and in selection of specimens likely to yield invasive enteric pathogens. J Clin Microbiol 1996;34:1161–1165.
Huicho L, Campos M, Rivera J, Guerrant RL: Fecal screening tests in the approach to acute infectious diarrhea: scientific overview. Pediatr Infect Dis J 1996;15:486–494.
Scerpella EG, Okhuysen PC, Mathewson JJ, Guerrant RL, Latimer E, Lyerly D, et al: Evaluation of a new latex agglutination test for fecal lactoferrin in travelers’ diarrhea. J Travel Med 1994;1:68–71.
Ruiz-Pelaez JG, Mattar M, Mattar S: Accuracy of fecal lactoferrin and other stool tests for diagnosis of invasive diarrhea at a Colombian pediatric hospital. Pediatr Infect Dis J 1999;18:342–346.
Miller JR, Barrett LJ, Kotloff K, Guerrant RL: A rapid test for infectious and inflammatory enteritis. Arch Intern Med1994;154:2660–2664.
Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre. How to read clinical journals. II. To learn about a diagnostic test. Can Med Assoc J 1981;124:703–710.
Gill CJ, Lau J, Gorbach SL, Hamer DH: Diagnostic accuracy of stool assays for inflammatory bacterial gastroenteritis in developed and resource-poor countries. Clin Infect Dis 2003;37:365–375.
McIver CJ, Hansman G, White P, Doultree JC, Catton M, Rawlinson WD: Diagnosis of enteric pathogens in children with gastroenteritis. Pathology 2001;33:353–358.
Huicho L, Garaycochea V, Uchima N, Zerpa R, Guerrant RL: Fecal lactoferrin, fecal leukocytes and occult blood in the diagnostic approach to childhood invasive diarrhea. Pediatr Infect Dis J1997;16:644–647.
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