Comparison of three non-culture techniques for detection of Chlamydia trachomatis in genital tract specimens

Chlamydial infection in asymptomatic infertile men attending an andrology clinic

Urethral swabs, first-catch urine or urine collected at least 2 h after the previous micturition, and semen swabs were collected from 131 asymptomatic men during the routine workup for infertility at the andrology clinic at Ga-Rankuwa Hospital, Medunsa. The urethral and seminal swabs were used for enzyme immunoassay (EIA) (IDEIA III), tissue culture, and direct immunofluorescent antibody (DFA) test (IMAGEN) to detect Chlamydia trachomatis, and similarly the urine was tested by EIA. In 82/131 (62.6%) cases all tests for chlamydiae were negative and in 49/131 (37.4%) cases at least one test was positive. Tissue culture detected 24/131 (18.3%) as positive for C. trachomatis. Urethral swab EIA detected 33/131 (25.2%) and DFA 34/131 (26%) positive patients. Urine EIA was positive in 33/131 cases (25.2%). Semen EIA was positive in 35/131 (26.7%) of cases of whom 7/131 (5.3%) were positive in semen EIA only (all samples were conformed by PCR). It would seem, therefore, that testing for the presence of chlamydia was incomplete if semen samples were not included. The positivity in only semen samples raises the possibility that the organisms are harbored in the epididymis, seminal vesicles, or the prostate.

Confirmation of the Syva MicroTrak enzyme immunoassay for chlamydia trachomatis by Syva Direct Fluorescent Antibody Test

BACKGROUND AND OBJECTIVES

The Syva Micro Trak enzyme immunoassay (EIA) is used widely for screening women infected with Chlamydia trachomatis. Confirmatory tests used in conjunction with EIA screening have shown that false-positive results are common.

GOALS

To evaluate the specificity of the Syva MicroTrak EIA by confirmation of positive specimens with the Syva Direct Fluorescent Specimen Test.

STUDY DESIGN

Of 6,039 endocervical specimens collected from women attending Colorado family planning clinics, 328 positive EIA results (5.4%) were obtained by Syva MicroTrak EIA. A random subset of 136 positive specimens was tested by Syva Direct Specimen Test. Twenty of 136 specimens (14.7%) negative by Syva Direct Specimen testing were also tested by Syva blocking antibody tests (9 of 20 positive, 45%) and Roche Amplicor polymerase chain reaction (PCR; 6 of 20 positive, 30%). Of 20 specimens positive by Syva MicroTrak EIA and negative by Syva Direct Specimen Test, 11 (55%) were also negative by blocking antibody and PCR, including three specimens with initial EIA sample-to-cutoff ratios greater than 2.

CONCLUSIONS

Confirmatory testing of Syva MicroTrak EIA positive specimens with Syva Direct Specimen Test showed that 14.7% were false positive. Coupling the Syva Direct Specimen test with either blocking antibody or PCR reduces the rate of false-positive results to 8%.

Polymerase chain reaction for the detection of Chlamydia psittaci in the feces of budgerigars

The polymerase chain reaction (PCR) targeting the ompA gene of Chlamydia psittaci was evaluated for its ability to detect chlamydiae in fecal specimens of budgerigars as compared with isolation procedures using cell culture and embryonated egg inoculations. Several procedures for PCR template DNA preparation were compared so as to determine their detection levels for chlamydiae propagated in cell culture in the presence of fecal materials. Tween-20 and proteinase K treatments followed by centrifugation of the template DNA were found to be an appropriate procedure for DNA preparation for primary PCR. Subsequent nested PCR was shown to detect 4.8 IFU/ml or 84 particles/ml of chlamydiae. Chlamydiae in 50 fecal specimens from apparently healthy budgerigars were examined by nested PCR and several other methods. Nested PCR detected chlamydiae at a higher rate (12/50, 24%) than the isolation procedure in embryonated eggs (6/50, 12%). Primary PCR combined with the isolation procedure in cell culture gave a detection rate (5/50, 10%) similar to that of isolation from embryonated eggs. Detection rates by primary PCR (1/50, 2%) and in cell culture (0%) were inferior to the other procedures.

Urine as an alternative to urethral swabs for the diagnosis of Chlamydia trachomatis in infertile males

Swabbing the urethrae of men has been the traditional approach for collecting specimens for detection of Chlamydia trachomatis. Recently, however, urine testing using enzyme immunoassay has yielded promising results. A total of 105 patients attending the Andrology Clinic at Ga Rankuwa Hospital, Medunsa were included in the study. These patients were asymptomatic and had no urethral discharge. Three endo-urethral swabs and first-catch urine were collected from each patient. The urethral swabs were used for enzyme immunoassay (EIA) (IDEIA III), tissue culture and direct immunofluorescent antibody (DFA) test (IMAGEN) to detect C. trachomatis. In addition about 15-30 ml of first-catch urine, or urine collected at least 2h after the previous micturition, was collected for each patient for EIA testing. Fifteen (14.3%) of 105 patients were positive on urethral swab EIA, in comparison with the DFA test in which 14 (13.3%) were positive. Eight (7.8%) were positive in tissue culture. Urine EIA was positive in 17 (16.2%) patients, of whom five (4.8%) were positive in urine EIA only. All EIA positive urines were confirmed by DFA. We recommend that first-catch urine or urine collected at least 2h after the previous micturition in infertile males may be considered a suitable alternative to urethral swab for chlamydial diagnosis because it is noninvasive and nontraumatic.

Detection of infections of the eye with Chlamydia trachomatis by the polymerase chain reaction

The aim of this study was to test the diagnostic feasibility of the polymerase chain reaction (PCR) for detection of infections with Chlamydia trachomatis in eye swabs from patients with conjunctivitis, and to establish the basic technique of the PCR for epidemiological survey. The results of the PCR were compared with the Mikro Trak immunofluorescence assay (IFA). From 49 specimens of patients with conjunctivitis, 31 were found positive by PCR (63%) and 23 by IFA (47%). On the other hand, in 10 normal eye specimens and 10 non-Chlamydia trachoma conjunctivitis specimens no Chlamydia trachomatis was detected.

Comparison of nine antigen detection kits for diagnosis of urogenital infections due to Chlamydia psittaci in koalas

Chlamydia psittaci is the major cause of infectious disease in the koala (Phascolarctos cinereus). It causes four disease syndromes in the koala, namely, conjunctivitis, rhinitis, cystitis, and infertility (females only). Diagnosis of chlamydial infections in koalas relies primarily on isolation of the organism in cell culture. Serology has generally not been useful, and little use has previously been made of the commercially available antigen detection kits. We examined the sensitivity, specificity, and usefulness of three direct fluorescent-antibody kits (Vet-IF [Cell Labs], IMAGEN [Celltech], Chlamydia-Direct IF [Bio Merieux]) and six antigen detection enzyme-linked immunosorbent assay (ELISA) kits (Clearview [Unipath], Surecell [Kodak], Pathfinder [Kallestad], Chlamydia-EIA [Pharmacia], Chlamydiazyme [Abbott], IDEIA [Celltech]) for the detection of urogenital infections in koalas. Laboratory studies showed that the direct fluorescent-antibody kits were the least sensitive in this case and did not detect fewer than 10(4) elementary bodies per ml, while most ELISA kits detected between 130 and 600 elementary bodies per ml. Field study results showed that the Clearview kit was the most sensitive (91%) compared with the IDEIA (88%) and the Surecell (73%) kits. All three kits were more sensitive than cell culture (36%), highlighting viability loss problems that occur during transport. This study showed that the Clearview kit is sensitive, specific, and easy to use for the detection of type II (urogenital) C. psittaci from koalas in the field and warrants further evaluation.

Chlamydia trachomatis antigen detection by Chlamydiazyme combined with Chlamydia Blocking Reagent verification

Several options exist for the detection of chlamydial infection in a routine laboratory setting. Enzyme immuno assay (EIA) technology offers rapid turn around of results and is less technically demanding than chlamydial cell culture. In addition, recently introduced EIA confirmatory reagents have the potential to improve the accuracy of EIA detection. We have evaluated one such confirmatory reagent (Chlamydia Blocking Reagent, Abbott Laboratories) to determine the accuracy of the Chlamydiazyme EIA with special regard to interpretation of low absorbance values. An initial series of 192 male urethral specimens showed that use of a lowered cut off level (absorbance value 0.05) compared with that recommended by the manufacturer increased sensitivity of the EIA from 0.73 to 0.83, thus motivating studies on this interpretative modification. Of 1101 EIA reactive specimens, 65% were determined to be chlamydia positive by the Chlamydia Blocking Reagent. The proportion of female cervical specimens that did not confirm positive was elevated compared with male urethral specimens, 43% vs. 5.7% respectively. In samples yielding absorbance from the recommended cut off level to 0.05 (approximately 50% below), the corresponding figures were 78% and 14% respectively. In 85 selected EIA reactive samples, examination by a direct immunofluorescence staining assay (DFA) (MicroTrak, Syva Inc.) revealed elementary bodies in 85% of 67 blocking test positive and in 24% of 18 blocking test negative samples. The possibility that Gram-negative bacteria were responsible for unconfirmed EIA reactive specimens was investigated using bacterial suspensions. While EIA reactivity was noted with several strains for Gram-negative bacteria, both the blocking reagent and DFA correctly verified the absence of chlamydial antigen.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of a chemiluminometric immunoassay and a direct immunofluorescence test for detecting Chlamydia trachomatis in urogenital specimens

A new chemiluminometric immunoassay (Magic Lite) and a direct immunofluorescence technique (MicroTrak) were compared with cell culture in the diagnosis of Chlamydia trachomatis infections. Both assays were evaluated using 260 genital specimens (89 men, 171 women), 26 of which were culture positive. The respective sensitivity of the chemiluminometric immunoassay and immunofluorescence technique was 88.5% and 84.6%, the specificity 97% and 99.6%, the positive predictive value 76.7% and 95.6%, and the negative predictive value 98.7% and 98.3%. Both methods could serve as an alternative to culture in the diagnosis of urogenital chlamydial infections.

Laboratory techniques for the diagnosis of chlamydial infections

Yolk-sac inoculation of embryonated eggs was superseded 25 years ago by the use of cell cultures (often McCoy) for the isolation of Chlamydia trachomatis. Centrifugation of specimens onto the cell monolayers was shown to increase sensitivity, but little of late has further improved sensitivity which is at least ten-fold greater than that of eggs. However, culture is slow and labour intensive so that non-cultural techniques without these drawbacks have come to dominate. Direct fluorescent antibody (DFA) tests are rapid and have sensitivities that range from 70% to 100% for men and 68% to 100% for women, and specificities that range from 87% to 99% for men and 82% to 100% for women; if the tests are read by competent observers the values are at the top end of the ranges. The detection rate may be enhanced even further by relatively low-speed centrifugation of specimens before staining. Skilled reading is not a feature of enzyme immunoassays (EIAs) which according to the literature have sensitivities that range from 62% to 97% for men and 64% to 100% for women, and specificities that range from 92% to 100% for men and 89% to 100% for women. However, comparison against poor reference tests is responsible for most of the higher values and the clinician should not be misled into believing that EIAs have excellent sensitivity; the lower values in the ranges are closer to reality. Furthermore, EIAs that are being designed for use by general practitioners should be regarded with the greatest caution since lack of sensitivity means that chlamydia-positive patients will go undetected. The polymerase chain reaction (PCR) is not bedevilled by insensitivity but it is no more sensitive than the most sensitive cell culture or DFA tests. PCR is unsuitable for routine diagnosis but has a place as a research tool. For men, examination of "first-catch" urine samples by the best of the non-cultural procedures provides an acceptable non-invasive approach to diagnosis; for women, the value of examining urine may be less, but needs to be thoroughly tested. However, there is little doubt that a Cytobrush used to obtain cervical specimens holds no practical advantage over a swab. Serological tests are reliant on the provision of paired sera for making a diagnosis; high antibody titres in single sera may be suggestive of an aetiological association in deep-seated chlamydial infections (epididymitis, arthritis, salpingitis, etc), but unequivocal interpretation is unusual, particularly in an individual case, since the distinction between a current and past infection is problematical.

Diagnostic value of the polymerase chain reaction for Chlamydia detection as determined in a follow-up study

The diagnostic value of the polymerase chain reaction (PCR) for detection of Chlamydia trachomatis in comparison with that of the culture technique was established in a follow-up study of 32 patients (81 samples) who were treated for a C. trachomatis infection. The PCR was performed with two different sets of primers, a genus-specific primer set directed against the rRNA genes and a C. trachomatis-specific set directed against the common endogenous plasmid. After treatment with doxycycline, all patients became culture negative after 1 week. Results for the detection of C. trachomatis by the PCR were in complete agreement with the results by the culture method of detection, except for one culture-negative sample, which was found to be positive by the PCR. The results indicated that 1 week after treatment, no residual chlamydial DNA was found in the samples. Therefore, the PCR can be used for monitoring infections by chlamydiae.

Detection of Chlamydia trachomatis in clinical specimens by the polymerase chain reaction

Sequences derived from the endogenous plasmid of Chlamydia trachomatis and from the genes coding for ribosomal 16S RNA of Chlamydia psittaci were used as primers and oligonucleotide probes for detection of chlamydiae by the polymerase chain reaction. The endogenous plasmid primers generated specific amplified products of 517 bp with all known Chlamydia trachomatis serovars. No specific products of Chlamydia psittaci and Chlamydia pneumoniae could be detected using these primers. With the rRNA primers specific amplified products of 208 bp were generated with Chlamydia psittaci, Chlamydia trachomatis and Chlamydia pneumoniae. No specific amplified products were detected with DNA isolated from a variety of microorganisms from the urogenital and the respiratory tract. Of 156 clinical specimens used for evaluation of the polymerase chain reaction, 26 were found to be positive for Chlamydia trachomatis on culture. All 26 culture positive samples were also found to be positive for Chlamydia trachomatis DNA by the polymerase chain reaction with both primer sets. Two culture negative samples were also found to be positive by this technique. The polymerase chain reaction thus seems to be a sensitive and reliable method for detection of Chlamydia trachomatis.