Evaluation of PCR, culture, and serology for diagnosis of Chlamydia pneumoniae respiratory infections.
We prospectively studied 156 patients with a diagnosis of community-acquired pneumonia requiring admission. Several respiratory specimens were obtained for the detection of Chlamydia pneumoniae by cell culture and PCR. Three serum samples were obtained from each patient. Serological diagnosis of a C. pneumoniae infection was determined by the microimmunofluorescence (MIF) test, the complement fixation (CF) test, and recombinant lipopolysaccharide (LPS) enzyme-linked immunosorbent assay (ELISA; referred to as the rDNA LPS ELISA). Twenty-three patients (15%) had serological results compatible with acute C. pneumoniae infection; nine (39%) of these subjects were C. pneumoniae PCR positive. Twenty-two patients (14%) had positive PCR results without serological evidence of an acute C. pneumoniae infection. An attempt was made to calculate the sensitivities and specificities of the MIF test, rDNA LPS ELISA, and PCR for the diagnosis of chlamydial community-acquired pneumonia. Several "gold standards" were defined. Generally, the sensitivities of the rDNA LPS ELISA and MIF were comparable, while the sensitivity of the CF test was shown to be very low. Independent of the gold standard used, the best PCR results were obtained with nasopharyngeal specimens. However, the predictive value of a positive C. pneumoniae PCR result for patients with community-acquired pneumonia remains unknown and may be low. Although a widely accepted gold standard is still lacking, the rDNA LPS ELISA may currently be the preferred tool for diagnosing acute respiratory Chlamydia infections in routine clinical practice. However, the MIF test remains the method of choice for determining the prevalence of C. pneumoniae infections in a given community.
Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center Rotterdam, The Netherlands. Verkooyen@kmic.fgg.eur.nl
R P
RP
Verkooyen
D
D
Willemse
S C
SC
Hiep-van Casteren
S A
SA
Joulandan
R J
RJ
Snijder
J M
JM
van den Bosch
H P
HP
van Helden
M F
MF
Peeters
H A
HA
Verbrugh
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000097:blood; D002690:Chlamydia Infections / Q000175:diagnosis*; D016993:Chlamydophila pneumoniae / Q000235:genetics / Q000254:growth & development / Q000276:immunology / Q000302:isolation & purification; D017714:Community-Acquired Infections / Q000175:diagnosis; D003168:Complement Fixation Tests; D003470:Culture Media; D004797:Enzyme-Linked Immunosorbent Assay; D005069:Evaluation Studies as Topic; D005260:Female; D005455:Fluorescent Antibody Technique; D006801:Humans; D008070:Lipopolysaccharides / Q000276:immunology; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000382:microbiology; D018410:Pneumonia, Bacterial / Q000175:diagnosis*; D016133:Polymerase Chain Reaction / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012698:Serologic Tests
D000907:Antibodies, Bacterial; D003470:Culture Media; D008070:Lipopolysaccharides