Clostridium perfringens (Stool) – Antigen
Conformément au Règlement de l’Ontario 671/92 de la Loi sur les services en français, les renseignements d’analyses de laboratoire liés à la présente page ne sont offerts qu’en anglais parce qu’ils sont de nature scientifique ou technique et destinés uniquement à l’usage des fournisseurs de soins de santé qualifiés et non aux membres du public.
Background
This page provides testing information for detection of Clostridium perfringens antigen from fecal specimens at Public Health Ontario (PHO). The causative agent of C. perfringens food poisoning is the C. perfringens enterotoxin (CPE).
For primary testing of other enteric organisms from fecal specimens, refer to the following pages:
- Enteric Bacteria (including Salmonella, Shigella, STEC, Plesiomonas, Yersinia, Aeromonas, Vibrio, or Campylobacter) – Culture and PCR
- Clostridioides difficile – Antigen, PCR, Susceptibility, and Typing
- Gastroenteritis – Stool Viruses
- Enteric Parasites – Microscopy
- Botulism – Guide for healthcare professionals (PHAC)
For primary testing of enteric organisms from food and environmental products, refer to the following webpage: Food Testing.
Updates
- As of March 26, 2025, this page was updated to include specific information on agents tested, acceptance criteria, requisition requirements, turnaround time, and methods used.
Testing Indications
- At PHO, primary testing of clinical specimens for Clostridium perfringens enterotoxin is restricted only to local health unit requests for case management and cluster/outbreak investigations.
- Limit specimen collection from ten symptomatic persons at the onset of the outbreak, when the causative agent is still unknown.
Acceptance/Rejection Criteria
- Specimens will be rejected if received from submitters other than local health units.
- Non-stool specimens (e.g. rectal swabs, intestinal washing content) will also be rejected if received.
- Specimens received NOT in frozen condition will be rejected.
Specimen Requirements
| Test Requested | Required Requisition(s) | Specimen Type | Minimum Volume | Collection Kit |
Clostridium perfringens |
Unformed stool |
2.0 ml |
Sterile container without medium |
Submission and Collection Notes
Only local health units can submit primary specimens (unformed stool) for Clostridium perfringens antigen testing.
Complete all fields of the requisition form.
Clearly identify on the requisition that Clostridium perfringens or an unknown foodborne outbreak is suspected.
Submit only one specimen per patient.
Label the container with the patient’s first and last name, date of collection, and one other unique identifier such as the patient’s date of birth or Health Card Number. Failure to provide this information may result in rejection or testing delay.
If the patient is part of a cluster/outbreak investigation, contact PHO Laboratory Customer Service at 416-235-6556/1-877-604-4567 prior to sample submission.
Storage and Transport
Place the sealed specimen container in a biohazard bag and properly seal bag. Specimens should be stored frozen and shipped to PHO on ice packs within the same day of collection. If specimens might not be able to arrive at PHO within 24 hours of collection, they should be stored frozen (- 20°C or lower) and shipped on ice packs as soon as possible. All specimens must be shipped in accordance to the Transportation of Dangerous Good Act.
Test Frequency and Turnaround Time (TAT)
Fecal specimen testing for Clostridium perfringens enterotoxin antigen detection is performed weekly on Wednesdays at PHO’s laboratory, Toronto location. Turnaround time is up to 8 days from receipt date.
STAT and Critical Specimens Testing
Priority testing for cluster/outbreak investigations is available upon request. If needed, contact PHO Laboratory Customer Service as 416-235-6556/1-877-604-4567 prior to sample submission.
Fecal specimen testing for Clostridium perfringens enterotoxin antigen is performed by enzyme-linked immunosorbent assay (ELISA) using the Health Canada authorized Clostridium perfringens Enterotoxin Test kit. The test kit uses polyclonal antibodies to detect C. perfringens enterotoxin.
Performance and Limitations: Performance data is limited, however some studies suggest a 34% to 87.4% positive percent agreement and 98% to 100% negative percent agreement of antigen ELISA compared to alternative methods. Cross-reactivity is not well established, however codetection with other etiologies of enteric illness may occur (e.g. C. difficile, norovirus).1,2,3,4
Interpretation
| Clostridium perfringens enterotoxin by EIA Result | Interpretation |
|---|---|
Detected |
Suggestive of C. perfringens enterotoxin food poisoning. False positive results and/or coinfection may occur. Clinical correlation required. |
Not detected |
A negative result does not rule out infection, as false negative results may occur. Repeat collection and testing if clinically indicated. |
Invalid |
Unable to perform antigen testing due to failure of the test controls. Repeat collection and testing if clinically indicated. |
Reporting
Results are reported to the physician, authorized health care provider (General O. Reg 45/22, s.18) or submitter as indicated on the requisition.
Results positive for Clostridium perfringens enterotoxin are reported to the local Medical Officer of Health as per the Ontario Health Protection and Promotion Act.
References
- Forward LJ, Tompkins DS, Brett MM. Detection of Clostridium difficile cytotoxin and Clostridium perfringens enterotoxin in cases of diarrhoea in the community. J Med Microbiol. 2003 Sep;52(Pt 9):753-757. doi: 10.1099/jmm.0.05119-0. PMID: 12909650.
- Asha NJ, Wilcox MH. Laboratory diagnosis of Clostridium perfringens antibiotic-associated diarrhoea. J Med Microbiol. 2002 Oct;51(10):891-894. doi: 10.1099/0022-1317-51-10-891. PMID: 12435070.
- Jackson SG, Yip-Chuck DA, Brodsky MH. Evaluation of the diagnostic application of an enzyme immunoassay for Clostridium perfringens type A enterotoxin. Appl Environ Microbiol. 1986 Oct;52(4):969-70. doi: 10.1128/aem.52.4.969-970.1986. PMID: 2877617; PMCID: PMC239152.
- Ishioka T, Aihara Y, Carle Y, Shigemura H, Kubomura A, Motoya T, Nakamoto A, Nakamura A, Fujimoto S, Hirai S, Oishi K, Nagaoka H, Kimura H, Murakami K. Contrasting Results from Two Commercial Kits Testing for the Presence of Clostridium perfringens Enterotoxin in Feces from Norovirus-Infected Human Patients. Clin Lab. 2020 May 1;66(5). doi: 10.7754/Clin.Lab.2019.190801. PMID: 32390391.
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