Kuipers J G, Scharmann K, Wollenhaupt J, Nettelnbreker E, Hopf S, Zeidler H
Department of Internal Medicine and Dermatology, Hannover Medical School, Germany.
J Clin Microbiol. 1995 Dec;33(12):3186-90. doi: 10.1128/jcm.33.12.3186-3190.1995.
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, Chlamydia EIA, 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 x 10(3), and PACE 2 and IDEIA detected 2 x 10(4) EB per ml. In peripheral blood, only PCR and MicroTrak detected C. trachomatis, with detection limits of 100 and 2 x 10(7) EB per ml, respectively. For peripheral blood leukocytes, the detection limits were 2 EB per ml for PCR and 2 x 10(4) EB per ml for MicroTrak, ChlamydiaEIA, IDEIA, and PACE 2. In synovial fluid, PCR detected 200, MicroTrak and IDEIA detected 2 x 10(5), and PACE 2 detected 10(6) EB per ml. ChlamydiaEIA was unable to detect 2 x 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.
衣原体诱导的反应性关节炎的常规微生物学诊断主要基于通过泌尿生殖道拭子或尿液检测沙眼衣原体。由于衣原体抗原、rRNA和DNA在发炎关节中的含量很低，因此需要高灵敏度的检测方法，不仅要在感染的原发部位，而且要在外周血、疑似传播载体的外周血白细胞以及滑液中检测沙眼衣原体。为了评估用于此目的的可能工具，测定了PCR、MicroTrak、衣原体酶免疫分析（Chlamydia EIA）、免疫诊断酶免疫分析（IDEIA）和PACE 2在尿液（urine）、外周血、外周血白细胞和滑液中检测特定数量纯化沙眼衣原体原体（EB）的灵敏度。在尿液中，PCR可检测到每毫升2个EB，MicroTrak和衣原体酶免疫分析可检测到每毫升2×10³个EB，PACE 2和免疫诊断酶免疫分析可检测到每毫升2×10⁴个EB。在外周血中，只有PCR和MicroTrak能检测到沙眼衣原体，检测限分别为每毫升100个和2×10⁷个EB。对于外周血白细胞，PCR的检测限为每毫升2个EB，MicroTrak、衣原体酶免疫分析、免疫诊断酶免疫分析和PACE 2的检测限为每毫升2×10⁴个EB。在滑液中，PCR可检测到每毫升200个EB，MicroTrak和免疫诊断酶免疫分析可检测到每毫升2×10⁵个EB，PACE 2可检测到每毫升10⁶个EB。衣原体酶免疫分析无法检测到滑液中每毫升2×10⁶个EB。总之，发现PCR是最灵敏的方法。所测试的其他方法的灵敏度比PCR至少低1000倍。因此，PCR应被视为衣原体诱导性关节炎常规诊断中最有前景的工具。
