Verkooyen R P, Willemse D, Hiep-van Casteren S C, Joulandan S A, Snijder R J, van den Bosch J M, van Helden H P, Peeters M F, Verbrugh H A
Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center Rotterdam, The Netherlands.
J Clin Microbiol. 1998 Aug;36(8):2301-7. doi: 10.1128/JCM.36.8.2301-2307.1998.
We prospectively studied 156 patients with a diagnosis of community-acquired pneumonia requiring admission. Several respiratory specimens were obtained for the detection of Chlamydia pneumoniae by cell culture and PCR. Three serum samples were obtained from each patient. Serological diagnosis of a C. pneumoniae infection was determined by the microimmunofluorescence (MIF) test, the complement fixation (CF) test, and recombinant lipopolysaccharide (LPS) enzyme-linked immunosorbent assay (ELISA; referred to as the rDNA LPS ELISA). Twenty-three patients (15%) had serological results compatible with acute C. pneumoniae infection; nine (39%) of these subjects were C. pneumoniae PCR positive. Twenty-two patients (14%) had positive PCR results without serological evidence of an acute C. pneumoniae infection. An attempt was made to calculate the sensitivities and specificities of the MIF test, rDNA LPS ELISA, and PCR for the diagnosis of chlamydial community-acquired pneumonia. Several "gold standards" were defined. Generally, the sensitivities of the rDNA LPS ELISA and MIF were comparable, while the sensitivity of the CF test was shown to be very low. Independent of the gold standard used, the best PCR results were obtained with nasopharyngeal specimens. However, the predictive value of a positive C. pneumoniae PCR result for patients with community-acquired pneumonia remains unknown and may be low. Although a widely accepted gold standard is still lacking, the rDNA LPS ELISA may currently be the preferred tool for diagnosing acute respiratory Chlamydia infections in routine clinical practice. However, the MIF test remains the method of choice for determining the prevalence of C. pneumoniae infections in a given community.
我们对156例确诊为需要住院治疗的社区获得性肺炎患者进行了前瞻性研究。采集了几份呼吸道标本，通过细胞培养和聚合酶链反应（PCR）检测肺炎衣原体。每位患者采集三份血清样本。通过微量免疫荧光（MIF）试验、补体结合（CF）试验和重组脂多糖（LPS）酶联免疫吸附测定（ELISA；称为rDNA LPS ELISA）对肺炎衣原体感染进行血清学诊断。23例患者（15%）的血清学结果与急性肺炎衣原体感染相符；其中9例（39%）患者肺炎衣原体PCR检测呈阳性。22例患者（14%）PCR检测结果为阳性，但无急性肺炎衣原体感染的血清学证据。我们试图计算MIF试验、rDNA LPS ELISA和PCR诊断衣原体社区获得性肺炎的敏感性和特异性。定义了几个“金标准”。一般来说，rDNA LPS ELISA和MIF的敏感性相当，而CF试验的敏感性非常低。无论使用何种金标准，鼻咽标本的PCR检测结果最佳。然而，肺炎衣原体PCR检测结果阳性对社区获得性肺炎患者的预测价值仍然未知，可能较低。尽管仍然缺乏广泛接受的金标准，但rDNA LPS ELISA目前可能是常规临床实践中诊断急性呼吸道衣原体感染的首选工具。然而，MIF试验仍然是确定特定社区肺炎衣原体感染患病率的首选方法。
