Cultural method for large-scale screening for Chlamydia trachomatis genital infection

Per-nasal swabbing as an aid to the diagnosis of chlamydial and adenovirus conjunctivitis

Two hundred and thirty four patients (adults and babies) with conjunctivitis were investigated by taking eye swabs and in addition by taking per-nasal swabs. Chlamydia trachomatis was isolated from 20 patients and adenovirus from 14 patients. Per-nasal swabbing led to a 53% increase in chlamydia diagnosis and a 27% increase in the diagnosis of adenovirus infection. It is suggested that per-nasal swabbing has an important role to play in detecting chlamydial conjunctivitis which itself may be an indicator for high morbidity in patients and their contacts.

Comparison of buffalo green monkey cells and McCoy cells for isolation of Chlamydia trachomatis in a microtiter system

A total of 1,229 urogenital samples of patients with sexually transmitted diseases and prostitutes were inoculated simultaneously in McCoy cells and Buffalo green monkey (BGM) cells by using a microtitration technique. BGM cells proved to be slightly more sensitive than McCoy cells, and they usually showed more and larger inclusions and were more resistant to cytotoxic substances in samples. The decrease in sensitivity as a result of mycoplasmal contamination was much more prominent in McCoy cells than in BGM cells.

Laboratory diagnosis of human chlamydial infections

Chlamydia trachomatis is a human pathogen that causes ocular disease (trachoma and inclusion conjunctivitis), genital disease (cervicitis, urethritis, salpingitis, and lymphogranuloma venereum), and respiratory disease (infant pneumonitis). Respiratory chlamydioses also occur with infection by avian strains of C. psittaci or infection by the newly described TWAR agent. Diagnosis of most acute C. trachomatis infections relies on detection of the infecting agent by cell culture, fluorescent antibody, immunoassay, cytopathologic, or nucleic acid hybridization methods. Individual non-culture tests for C. trachomatis are less sensitive and specific than the best chlamydial cell culture system but offer the advantages of reduced technology and simple transport of clinical specimens. Currently available nonculture tests for C. trachomatis perform adequately as screening tests in populations in which the prevalence of infection is greater than 10%. A negative culture or nonculture test for C. trachomatis does not, however, exclude infection. The predictive value of a positive nonculture test may be unsatisfactory when populations of low infection prevalence are tested. Tests that detect antibody responses to chlamydial infection have limited utility in diagnosis of acute chlamydial infection because of the high prevalence of persistent antibody in healthy adults and the cross-reactivity due to infection by the highly prevalent C. trachomatis and TWAR agents. Assays for changes in antibody titer to the chlamydial genus antigen are used for the diagnosis of respiratory chlamydioses. A single serum sample that is negative for chlamydial antibody excludes the diagnosis of lymphogranuloma venereum.

Simplified culture procedure for large-scale screening for Chlamydia trachomatis infections

A method that uses a 48-well tissue culture cluster tray system for the isolation of Chlamydia trachomatis is described. The cluster tray system was as sensitive (100%) as and more time efficient than the conventional cover slip method, thereby being considerably cost saving. With both culture methods, the prevalence rates of genital carriage of C. trachomatis in women attending clinics for legal abortion and for cervical dysplasia were 5% (31 of 641 patients) and 2% (3 of 148 patients), respectively.

Adult follicular conjunctivitis and neonatal ophthalmia in a Liverpool eye hospital, 1980-1984

In the five year period between 1980 and 1984, 2146 adults and 172 neonates suffering from acute conjunctivitis underwent laboratory investigation for Chlamydia trachomatis (CT), Adenoviruses (AV), Herpes Simplex Virus (HSV) and pathogenic bacteria. Epidemiology and clinical features are presented and discussed. CT was detected in 29 per cent of neonates with conjunctivitis. 5.6 per cent of adults and older children investigated for follicular conjunctivitis were CT positive. There was a significant female preponderance among CT positive neonates of 1.9:1 (p less than 0.02). 91 per cent of neonates and 62 per cent of adults in whom CT was detected were receiving some sort of treatment. Serotypes 7, 3, 10, 4 and 8 were responsible in decreasing order of frequency for 96 per cent of AV infections. Serotype 7 was seen for the first time in an adult age distribution. HSV was isolated in 1.3 per cent of cases in the absence of typical lid or corneal lesions. Viral infection was not detected in any neonate. Bacterial infection was a more likely cause than CT in neonates if infection had persisted longer than 5 weeks (p much less than 0.001). Neonates with Staph aureus infection tended to present earlier in the course of disease than those with Haemophilus sp or Pneumococcus (p less than 0.05).

Evaluation of a seven day course of oxytetracycline in women with chlamydial cervicitis

In an urban clinic for sexually-transmitted diseases, 270 women with cervical swabs culture positive for Chlamydia trachomatis were treated with 250 mg oxytetracycline orally four times daily for 7 days. Chlamydial infection was found again in 17 of 220 (7.3%) women examined one month after treatment, and in 12 of 113 (9.7%) women reexamined three months after treatment. Even in cases where reinfection seemed unlikely, only 177 of 198 (89%) were cured. Most post-treatment infections were not clinically apparent, and laboratory follow-up was essential for evaluation of chemotherapy.

Evaluation of ciprofloxacin 500 mg twice daily for one week in treating uncomplicated gonococcal chlamydial, and non-specific urethritis in men

Ciprofloxacin, a quinolone antibacterial, was evaluated in the treatment of gonococcal, chlamydial, gonococcal and chlamydial, and non-gonococcal non-chlamydial urethritis. The dosage regimen used was 500 mg orally twice a day for seven days. Of the 56 patients evaluated 22 had gonococcal infection only, 13 were infected with Chlamydia trachomatis only, seven had combined infection, and 14 were harbouring neither of these organisms. Neisseria gonorrhoeae was cleared in all the 29 patients with or without chlamydial infection. Of those who denied having sexual intercourse during the follow-up period, post gonococcal urethritis (PGU) developed in 12 (63%) out of 19, C trachomatis was isolated again from 11 (78%) out of 14, and urethritis recurred in five (55%) out of nine patients with non-gonococcal non-chlamydial infection. There was also evidence that the dosage regimen used was only partially effective against Ureaplasma urealyticum.

Micro direct inoculation method for the isolation and identification of Chlamydia trachomatis

Current standard procedures for the isolation and identification of Chlamydia trachomatis are laborious. A more rapid method for the isolation and identification of C. trachomatis has been developed. This method features the use of a multiwell microplate to which trypsinized McCoy cells and specimens are added simultaneously, followed by centrifugation. A simplified one-step iodine-glycerol staining procedure is used to detect the chlamydial inclusions. The requirements of the conventional macro method for preseeding cell monolayers and for the use of cumbersome cover slips in glass vials are eliminated. Studies on 345 clinical specimens showed that the micro method is as sensitive as the conventional method but can be performed more conveniently, rapidly, and economically.

Detection of Chlamydia trachomatis inclusions in McCoy and HeLa-229 cells: an alternative staining technique using toluidine blue

Toluidine blue staining was used to detect Chlamydia trachomatis inclusions in both McCoy and HeLa-229 cells from clinical specimens. This method was more sensitive than iodine staining for detecting C trachomatis inclusions in both McCoy and HeLa-229 cells and also more sensitive than Giemsa staining for detecting chlamydial inclusions in HeLa-229 cells. While its sensitivity for detection of chlamydial inclusions in McCoy cells is equal to that of Giemsa staining, toluidine blue staining is easier and faster to perform.

Detection of Chlamydia trachomatis inclusions in Mccoy cell cultures with fluorescein-conjugated monoclonal antibodies

We compared two methods for identification of Chlamydia trachomatis inclusions in McCoy cell monolayers: conventional iodine staining and immunofluorescence staining with monoclonal antibodies against the species-specific major outer membrane protein antigen of C. trachomatis. Among 878 urethral and cervical specimens tested in parallel, the immunofluorescence method detected eightfold more inclusions per monolayer, identified a higher proportion of positive specimens on first passage (98 versus 62% by iodine staining; P less than 0.01), and improved overall sensitivity (98% of total positive specimens detected versus 84% by iodine staining; P less than 0.01). Improved sensitivity was most evident in specimens with low numbers of inclusions. Compared with conventional iodine staining, immunofluorescence staining with monoclonal antibodies improves sensitivity and offers more rapid detection of chlamydial inclusions in cell culture.

Chlamydia trachomatis in general practice: a preliminary report

A case of Chlamydia trachomatis diagnosed in general practice is described. It is argued that, in the future, the culture methods used in this study, together with the application of at risk criteria, could identify in general practice most patients suffering from chlamydial disease.

Provision of a chlamydial culture service to a sexually transmitted diseases clinic

Urethral specimens from 215 men were inoculated on to McCoy cell cultures, both at the local laboratory and at a central reference laboratory, Chlamydia trachomatis was isolated from 58 (28%) patients; 12 of these isolates were, however, obtained only at the local laboratory. The results show the feasibility and convenience of a central laboratory supplying a peripheral laboratory with uninoculated prepared cell cultures. Such a service is not only more cost effective but obviates the problems of transporting specimens to a central laboratory.

Quantitative study of Chlamydia trachomatis in genital infection

Chlamydia trachomatis inclusion counts on inoculated McCoy cell coverslips were used as an index of the degree of infection of the cervix in women and of the urethra in men with urethritis. High inclusion counts were obtained significantly more often from men than from women, from women with cervical ectopy, and from women who had had recent sexual intercourse. Low inclusion counts were significantly more common in men with a past history of gonococcal urethritis. Higher chlamydial isolation rates in women with gonorrhoea and in women taking the contraceptive pill could not be attributed to a greater degree of infection, since inclusion counts were not raised in these patients. There was evidence that strains of C trachomatis might vary in their ability to establish themselves in the genital tract because high counts in men with NGU were associated with high counts in their female consorts and the levels of counts in men were associated with the frequency of chlamydial isolation from their female consorts. The relatively simple technique of inclusion counts in cultures for chlamydia from the genital tract may yield valuable information about the behaviour of different strains of C trachomatis in causing pathological changes, in the transmission of infection between individuals, and in the response to specific chemotherapy.