Diagnostic utility of PCR-enzyme immunoassay, culture, and serology for detection of Chlamydia pneumoniae in symptomatic and asymptomatic patients.
To assess the utility of PCR-enzyme immunoassay (EIA) for diagnosis of acute infection with Chlamydia pneumoniae, we compared tissue culture, PCR-EIA, direct fluorescent-antibody (DFA) stain, and serology in studies with 56 patients with respiratory symptoms and 80 asymptomatic persons. Thirty-five patients were positive by either culture or PCR-EIA, and 101 were negative by both assays. Thirty specimens from symptomatic patients and one from an asymptomatic patient were culture positive; 23 of these were also PCR-EIA positive. Of the eight culture-positive, PCR-EIA-negative specimens, five were DFA negative and three were DFA positive. Four additional specimens were culture negative and PCR-EIA positive; of these, three were DFA positive and one was DFA negative. When we used culture- and/or DFA-positive results as a reference or "gold standard," the sensitivity and specificity of PCR were 76.5 and 99.0%, respectively. When we used PCR- and/or DFA-positive results as the reference, the sensitivity of culture was 87.5%. On the basis of single acute serum specimens, only 8 of these 35 patients had diagnostic antibody titers. Of the asymptomatic patients, 75% had immunoglobulin G or immunoglobulin M antibody to C. pneumoniae; 15 (18.8%) of these had antibody levels considered to be diagnostic of acute infection. This multicenter study indicates that culture and/or PCR-EIA is more reliable for prompt diagnosis of C. pneumoniae infection than single-point serology alone.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
C A
CA
Gaydos
P M
PM
Roblin
M R
MR
Hammerschlag
C L
CL
Hyman
J J
JJ
Eiden
J
J
Schachter
T C
TC
Quinn
D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood; D001431:Bacteriological Techniques / Q000706:statistics & numerical data; D002648:Child; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D016993:Chlamydophila pneumoniae / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D003951:Diagnostic Errors; D005069:Evaluation Studies as Topic; D006801:Humans; D007124:Immunoenzyme Techniques / Q000706:statistics & numerical data; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D016133:Polymerase Chain Reaction / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D012698:Serologic Tests / Q000706:statistics & numerical data
D000907:Antibodies, Bacterial; D007074:Immunoglobulin G; D007075:Immunoglobulin M