Sensitivities of PCR, MicroTrak, ChlamydiaEIA, IDEIA, and PACE 2 for purified Chlamydia trachomatis elementary bodies in urine, peripheral blood, peripheral blood leukocytes, and synovial fluid

Abstract

Routine microbiological diagnosis of Chlamydia-induced reactive arthritis is based mainly on the detection of Chlamydia trachomatis with urogenital swabs or in urine. Because chlamydial antigen, rRNA, and DNA are present in low quantities in the inflamed joint, highly sensitive assays are needed to detect C. trachomatis not only at the primary site of infection but also in peripheral blood and peripheral blood leukocytes, which are suspected carriers for dissemination, and in synovial fluid. To evaluate possible tools for this purpose, the sensitivities of PCR, MicroTrak, ChlamydiaEIA, IDEIA, and PACE 2 for the detection of defined numbers of purified C. trachomatis elementary bodies (EB) in urine, peripheral blood, peripheral blood leukocytes, and synovial fluid were determined. In urine, PCR detected 2, MicroTrak and ChlamydiaEIA detected 2 ؋ 10 3 , and PACE 2 and IDEIA detected 2 ؋ 10 4 EB per ml. In peripheral blood, only PCR and MicroTrak detected C. trachomatis, with detection limits of 100 and 2 ؋ 10 7 EB per ml, respectively. For peripheral blood leukocytes, the detection limits were 2 EB per ml for PCR and 2 ؋ 10 4 EB per ml for MicroTrak, ChlamydiaEIA, IDEIA, and PACE 2. In synovial fluid, PCR detected 200, MicroTrak and IDEIA detected 2 ؋ 10 5 , and PACE 2 detected 10 6 EB per ml. ChlamydiaEIA was unable to detect 2 ؋ 10 6 EB per ml in synovial fluid. In summary, PCR was found to be the most sensitive method. The sensitivities of the other methods tested were at least 1,000 times lower than that of PCR. PCR should therefore be considered a most promising tool for routine diagnosis of Chlamydia-induced arthritis.

Comparison of clinical performance of antigen basedenzyme immunoassay (EIA) and major outer membrane protein (MOMP)-PCR for detection of genital Chlamydia trachomatis infection

“…There are some studies that reported false positive results and less specificity for antigen-EIA, indicating the need for verification of positive results by other methods such as DNA amplification ( 16 , 17 ). The variable performance of EIA for detection of C.trachomatis might be due to patient characteristics such as gender and specimen type ( 17 , 18 ). One study reported the sensitivity of EIA was 73% in endocervical swabs from women and 60% in endourethral swabs from men ( 19 ).…”

Chlamydia andBorrelia DNA in synovial fluid of patients with early undifferentiated oligoarthritis: Results of a prospective study

“…The sensitivities of the PCR methods were determined by serial dilutions of Ct, Bb sensu stricto , Borrelia afzelii , and Borrelia garinii in synovial fluid. The median detection limit was 2 elementary bodies per ml synovial fluid by Ct PCR and 10 Borrelia organisms per ml synovial fluid by Bb PCR (23, 24). The PCR results from the UOA patients were compared with the PCR results from patients with definite RA, Lyme arthritis, and CIA according to the above‐mentioned criteria.…”

Das Konzept der reaktiven Arthritiden. Entstehung, aktueller Stand und Perspektiven

“…1996;Li et al, 1996;Liebling et al. 1994;Li et aL, 1996; J. G. Kuipers sowie angrenzender Organe und Kompartimente in der Zukunft vermutlich zunehmend Patienten mit reaktiven Arthritiden identifizieren, die an einer persistierenden Infektion extraartikulärer Organe leiden [Kuipers et al, 1995]. Die Beobachtung persistierender asymptomatischer urogenitaler C. trachomatis Infektionen zum Zeitpunkt der Arthritis [Wollenhaupt et al, 1995;Leirisalo-Repo und Repo, 19921 Häufig wird der extraartikuläre Erregernachweis nicht gelingen.…”