Abstract
A complement fixation (CF) test, a micro-immunofluorescence (micro-IF) test and an enzyme immunoassay (EIA) using Re-lipopolysaccharide as antigen were compared in the diagnosis of chlamydial infection in 136 mainly elderly patients hospitalized with community-acquired pneumonia during aChlamydia pneumoniae epidemic in Finland in 1986–1987. Chlamydial pneumonia was diagnosed in 58 (42.6 %) of the 136 pneumonia patients; 44 (75.9 %) of them could be shown by micro-IF to be caused byChlamydia pneumoniae, three byChlamydia psittaci and four byChlamydia spp. Only 5 (11.4 %) of 44 patients withChlamydia pneumoniae pneumonia were IgM-positive, indicating that the majority of cases were reinfections. In this population of mainly elderly patients the CF test was insensitive, being positive in only 6 (10.3 %) of 58 cases of chlamydial pneumonia. The EIA detected 72.4 % of cases and micro-IF 87.9 % of cases (including infections withChlamydia pneumoniae, Chlamydia psittaci andChlamydia spp.). In the EIA 77 % of positive cases were positive in serum samples taken a week apart, whereas the corresponding figure for micro-IF was 50 %. In micro-IF the measurement of IgA antibody levels is recommended and IgM-positive sera should be retested after removal of IgG antibody to avoid false-positive findings due to presence of rheumatoid factor. The collection of a third serum sample, for instance one month after onset, is also recommended, since half of the patients showed a diagnostic response in the micro-IF only in the sera taken one month apart.
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Saikku P, Wang SP, Kleemola M, Brander E, Rusanen E, Grayston JT: An epidemic of mild pneumonia due to an unusual strain ofChlamydia psittaci. Journal of Infectious Diseases 1985, 151: 832–839.
Grayston JT, Kuo CC, Wang SP, Altman J: A newChlamydia psittaci strain, TWAR, isolated in acute respiratory tract infections. New England Journal of Medicine 1986, 315: 161–168.
Marrie TJ, Grayston TJ, Wang SP, Kuo CC: Pneumonia associated with TWAR strain ofChlamydia. Annals of Internal Medicine 1987, 106: 507–511.
Kleemola M, Saikku P, Visakorpi R, Wang SP, Grayston JT: Epidemics of pneumonia caused by TWAR, a newChlamydia organism, in military trainees in Finland. Journal of Infectious Diseases 1988, 157: 230–236.
Fang GD, Fine M, Orloff J, Arisumi D, Yu VL, Kapoor W, Grayston JT, Wang SP, Kohler R, Muder RR, Yee YC, Rihs JD, Vickers RM: New and emerging etiologies for community-acquired pneumonia with implications for therapy: a prospective multicentre study of 359 cases. Medicine 1990, 69: 307–316.
Grayston JT, Campbell LA, Kuo CC, Mordhorst CH, Saikku P, Thom DH, Wang SP: A new respiratory tract pathogen:Chlamydia pneumoniae strain TWAR. Journal of Infectious Diseases, 1990, 161: 618–625.
Thom DM, Grayston JT, Wang SP, Kuo CC, Altman J:Chlamydia pneumoniae, strain TWAR,Mycoplasma pneumoniae and viral infections in acute respiratory disease in a university student health clinic population. American Journal of Epidemiology 1990, 132: 248–256.
Cles L, Stamm W: Use of HL cells for improved isolation and passage ofChlamydia pneumoniae. Journal of Clinical Microbiology 1990, 28: 938–940.
Kuo CC, Grayston JT: A sensitive cell line, HL cells, for isolation and propagation ofChlamydia pneumoniae strain TWAR. Journal of Infectious Diseases 1990, 162: 755–758.
Wong KH, Skelton SK, Chan YK: Efficient culture ofChlamydia pneumoniae with cell lines derived from the human respiratory tract. Journal of Clinical Microbiology 1992, 30: 1625–1630.
Sillis M, White P, Caul EO, Paul ID, Treharne J: The differentiation ofChlamydia species by antigen detection in sputum specimens from patients with community-acquired acute respiratory infections. Journal of Infection 1992, 25, Supplement 1: 77–86.
Ekman MR, Grayston JT, Visakorpi R, Kleemola M, Kuo CC, Saikku P: An epidemic ofChlamydia pneumoniae infection in military conscripts. Clinical Infectious Diseases 1993, 17: 420–425.
Nurminen M, Leinonen M, Saikku P, Mäkelä PH: The genus-specific antigen ofChlamydia. Resemblance to the lipopolysaccharide of enteric bacteria. Science 1983, 220: 1279–1281.
Koskela M, Leinonen M: Comparison of ELISA and RIA for measurement of pneumococcal antibodies before and after vaccination with 14-valent pneumococcal capsular poly-saccharide vaccine. Journal of Clinical Pathology 1981, 34: 93–98.
Wang SP, Grayston JT: Microimmunofluorescence serological studies with the TWAR organism. In: Oriel JD, Ridgeway G, Schachter J, Taylor-Robinson D, Ward M (ed): Chlamydial infections. Cambridge University Press, Cambridge, 1986: 329–332.
Kerttula Y, Leinonen M, Koskela M, Mäkelä PH: The etiology of pneumonia. Application of bacterial serology and basic laboratory methods. Journal of Infection 1987, 14: 21–30.
Jokinen C: The etiology and risk factors in population based survey of community acquired pneumonia in Central Finland, Original Reports 5/1991. University of Kuopio, Kuopio, Finland, 1991.
Ozanne G, Lefebvre J: Specificity of the microimmunofluorescence assay for the serodiagnosis ofChlamydia pneumoniae infection. Canadian Journal of Microbiology 1992, 38: 1185–1189.
Verkooyen RP, Hazenberg MA, Van Haaren GH, Van Den Bosch JM, Snijder RJ, Van Helden HP, Verbrugh HA: Age-related interference withChlamydia pneumoniae microimmunofluorescence serology due to circulating rheumatoid factor. Journal of Clinical Microbiolology 1992, 30: 1287–1290.
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Ekman, M.R., Leinonen, M., Syrjälä, H. et al. Evaluation of serological methods in the diagnosis ofChlamydia pneumoniae pneumonia during an epidemic in Finland. Eur. J. Clin. Microbiol. Infect. Dis. 12, 756–760 (1993). https://doi.org/10.1007/BF02098463
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DOI: https://doi.org/10.1007/BF02098463