Recent developments in the laboratory diagnosis of chlamydial infections

There are two main approaches to diagnosing infections by Chlamydia and Chlamydophila spp. in mammals and birds. The first involves the direct detection of the agent in tissue or swab samples, while the second involves the serological screening of blood samples for the presence of anti-chlamydial antibodies. Ultimately, the test that is used is dependent on the types of samples that are submitted to the diagnostic laboratory for analysis. The present paper gives an overview on methodologies and technologies used currently in diagnosis of chlamydial infections with emphasis on recently developed tests. The performance characteristics of individual methods, such as the detection of antigen in smears and in pathological samples, the isolation of the pathogen, various antibody detection tests and DNA-based methods utilising conventional and real-time PCR, as well as DNA microarray technology are assessed, and specific advantages and drawbacks are discussed. Further, a combination of a specific real-time PCR assay and a microarray test for chlamydiae is proposed as an alternative reference standard to isolation by cell culture.     

Isolation of Chlamydia psittaci from cases of conjunctivitis in a colony of cats

This report describes the isolation in cell cultures of Chlamydia psittaci from cases of conjunctivitis in a colony of cats. The organism was identified in McCoy cell monolayers by staining the intracytoplasmic chlamydial inclusions with a fluorescent antibody technique, and serological evidence of chlamydial infection in cats was obtained by indirect immunofluorescence. The possible role of C psittaci as an ocular, upper respiratory and reproductive tract pathogen in cats is discussed.     

Evidence of Chlamydophila psittaci infection in captive Amazon parrots in Brazil.

The prevalence of Chlamydophila psittaci (formerly Chlamydia psittaci) infection was assessed in 95 apparently healthy, captive Amazon parrots from three breeder collections in southeastern and west-central Brazil. Cloacal swabs from 95 birds were tested for chlamydial antigen, which was detected by direct immunofluorescence (DIF), and serum samples from 44 of these birds were tested for antibodies to C. psittaci using an enzyme-linked immunosorbent assay. The prevalences of active infection as detected by DIF were 16.7%, 22.2%, and 56.1%, and seroprevalences were 100%, 87.5%, and 60% in flocks A, B, and C, respectively. We can therefore infer that C. psittaci may be widespread in captive parrot populations in Brazil.     

Evaluation of an immunofluorescence test on direct smears of conjunctival and urogenital swabs taken from koalas for the detection of Chlamydia psittaci

The Chlamydia-Cel Vet IF Test (CCVIT), a commercially available immunofluorescence test for use on direct smears of clinical specimens, was evaluated in a colony of 43 captive koalas. The test is based on a monoclonal antibody directed against the chlamydial common group specific lipopolysaccharide antigen. Swabs were taken from conjuncitva and penis or urogenital sinus and used for direct smear evaluation and cell culture isolation. Compared with isolation of the organism in cell culture, the CCVIT on direct smears of conjunctival swabs presented a sensitivity of 88%, a specificity of 100%, a positive predictive value (PV+) of 100% and a negative predictive value (PV-) of 97%. The CCVIT on direct smears of urogenital swabs presented a sensitivity of 90%, a specificity of 84%, a PV+ of 86% and a PV- of 89%. The overall sensitivity was 89% (95% confidence interval [CI] of 71% to 97%), the specificity 94% (95% CI of 84% to 98%), the PV+ 89% and the PV- 94%. It was concluded that the CCVIT on direct smears was suitable as a diagnostic screening test for the detection of Chlamydia psittaci in koalas.     

Chlamydia abortion in sheep: possibilities for serological diagnosis using a competitive ELISA and insight into the epidemiologic situation in Switzerland]

466 sheep sera out of 19 flocks in Switzerland were examined by a competitive enzyme linked immunosorbent assay (cELISA) for antibodies against Chlamydia psittaci "serotype 1" ("ovine enzootic abortion"). Since numerous positive reactors were found in flocks without abortion history, 30 fecal samples out of two of these flocks were examined by PCR for evidence of chlamydial DNA. One of these samples turned out to contain DNA of Chlamydia psittaci "serotype 1". These results suggest, that in Switzerland "serotype 1" of Chlamydia psittaci is widespread not only as cause of chlamydial abortion but also as latent intestinal infection in sheep. The resulting difficulties for serological diagnosis of chlamydial abortion and possible solutions based on the cELISA are discussed. The complement fixation test (CFT), still considered as standard method for serological examination for Chlamydiae, has additionally been applied.     

Diagnosis of avian chlamydiosis: specificity of the modified Giménez staining on smears and comparison of the sensitivity of isolation in eggs and three different cell cultures.

For the diagnosis of chlamydiosis in dead and live birds different methods were compared for their sensitivity and specificity. The specificity of the modified Giménez staining and the direct immunofluorescence (DIF) test for direct demonstration of Chlamydia psittaci in organ, cloacal and/or conjunctival smears was examined. The sensitivity of the isolation of Chlamydia psittaci in 6 days embryonated specific pathogen free (SPF) chicken eggs, Buffalo Green Monkey (BGM) cell line, McCoy cell line and Vero cell line was compared. On smears, the direct immunofluorescence test was more specific than the modified Giménez staining. The concordance between the results of both detection methods was 80%. The BGM cell culture was the most sensitive artificial host for isolation of Chlamydia psittaci, followed by the embryonated eggs, the Vero cell line and the McCoy cell line. The concordance between the results of isolation in BGM cell culture and eggs was 96.5%, while it was 86% between the results of isolation in BGM cell culture and Vero cell culture and only 65.5% between the results of isolation in BGM cell culture and McCoy cell culture. For dead bird species, chlamydiosis could be diagnosed more often using DIF on smears than with isolation. The concordance between the results of the DIF on smears and isolation followed by DIF was 91%.     

Preparation and use of a monoclonal antibody to detect Chlamydia psittaci antigen in paraffin-embedded tissue sections

A murine monoclonal antibody prepared against an ovine abortion isolate of Chlamydia psittaci (A22/Teramo) revealed specific binding to a 57 kDa chlamydial antigen in immunoblotting studies. The monoclonal antibody was able to detect intracytoplasmic chlamydial inclusions and scattered elementary bodies in infected McCoy cell culture, and on formalin-fixed paraffin-embedded tissue sections both from experimentally infected mice and from fetal membranes of cases of ovine enzootic abortion.     

More than classical Chlamydia psittaci in urban pigeons

In the literature, studies of Chlamydia infection in birds have usually been confined to the search for Chlamydia (C., formerly Chlamydophila) psittaci, so that little is known about the presence of other chlamydial agents. In the present study, cloacal swabs and faeces samples of urban pigeons have been examined by real-time PCR, DNA microarray assays and partial ompA sequencing. Whilst C. psittaci was the predominant chlamydial agent in this pigeon population (75.8% of all Chlamydiaceae positives), the combined use of highly specific and sensitive molecular assays facilitated the detection of atypical serovars of C. psittaci, as well as other species of Chlamydia, such as C. abortus. Detection of C. pecorum and C. trachomatis from an avian host is reported here for the first time. Rather unexpectedly, 19.5% of all Chlamydiaceae-positive cases turned out to be infected with non-classified organisms. The considerable prevalence of these novel agents raises the question of their epidemiological importance and possible role as pathogens. Future surveys in domestic and wild birds will have to take the extended variety of chlamydial organisms into account.     

Studies on the response of ewes to live chlamydiae adapted to chicken embryos or tissue culture.

Ewes infected before gestation with chicken embryo or tissue culture adapted chlamydial strain B-577 were challenge inoculated with the homologous strain at four to 18 weeks of gestation. The ewes responsed with group specific complement fixing antibody titers of 1:8 to 1:256 by the second week after initial infection. A secondary antibody response in the surviving challenge inoculated ewes occurred at the time of lambing and reached titers of 1:32 to 1:256 by the second week after parturition. Group specific complement fixing antibodies did not appear to play a significant role in resistance to chlamydial infection. Ewes infected with the chicken embryo adapted strain B-577 excreted chlamydiae in their feces 60 days after inoculation. However, chlamydiae were not recovered from feces of ewes infected with the tissue culture adapted strain B-577. Placentas of ewes challenge inoculated by the intravenous route were consistently infected. Chlamydiae were recovered from placentas, some fetuses and lambs. In two instances when challenge inoculation was given by the intramuscular route, infection was detected only by the direct fluorescent antibody method.     

Detection of Chlamydia psittaci from various animal species by reverse passive haemagglutination

A reverse passive haemagglutination test (RPH) has previously been developed to detect the genus-specific antigen of Chlamydia. Clinical samples were obtained from various sites of different animal species. The RPH test detected chlamydial antigen from clinical cases of conjunctivitis in cats, abortion in sheep and psittacosis in birds. Although not as sensitive as cell culture isolation, this test has the advantages of rapidity and of detecting antigen from dead chlamydiae.     

Comparative titers of egg assay against immunofluorescent assay of Chlamydia psittaci.

A comparison of titers was made between an egg assay and a direct fluorescent antibody assay of three chlamydial strains propagated in Vero cells with and without cortisone plus cytochalasin B. The titer of NJ-1 strain was similar in the egg titration and the fluorescent antibody assay in the untreated sample and a little lower for the sample treated with cytochalasin B and cortisone. The SCT and CDC strains had approximately the same titers in the egg titration and the fluorescent antibody assay for samples with and without the antimetabolites.     

Isolation and identification of Chlamydia psittaci from pet birds

Culturing of Chlamydia psittaci from pet birds requires the inoculation of a susceptible living host system with suspensions of various tissues from dead birds or with tracheal and/or cloacal swabs and fresh feces from live birds. Cell cultures have been used as the host system. The most commonly used cell cultures for isolation of C psittaci from pet birds are McCoy and mouse L cells. The sensitivity and specificity of cell culture equals or surpasses embryonating chicken eggs and mice, and results can be obtained in less than 7 days. To obtain satisfactory results, the inoculum must be centrifuged onto the cell cultures at 37 C, and the cells must be treated with a metabolic inhibitor such as colchicine or cycloheximide. Chlamydia psitaci can be detected in infected cells by use of fluorescent antibody, Giemsa, or Gimenez staining.     

Detection of chlamydial antibody by fetal serology--an aid to the diagnosis of ovine abortion.

Two serological tests (indirect immunofluorescence and enzyme-linked immunosorbent assay) were developed for the detection of fetal antibody to Chlamydia psittaci. Fetal blood and thoracic fluid from 126 field cases of suspected ovine chlamydial abortion were examined using both tests. Placenta and fetal tissues (lung, liver, and kidney) from the same animals were also examined by the following conventional diagnostic methods: isolation in McCoy cells, detection of chlamydial lipopolysaccharide (LPS), modified Ziehl-Nielsen staining, and direct fluorescent antibody staining of chlamydia in frozen cryostat sections. Seventy cases were positive by fetal serology, and of these, 68 were also positive by isolation and/or LPS detection. The remaining 56 cases had negative fetal serology, and of these, 39 were positive by isolation and/or LPS detection. Results indicate that fetal serology, although less sensitive than either isolation in McCoy cells or detection of chlamydial LPS antigen, may be of particular use when placenta is not available.     

Evaluation of the polymerase chain reaction in comparison with other diagnostic methods for the detection of Chlamydia psittaci.

Various diagnostic methods exist for the detection of Chlamydia psittaci. In the current study, the test performance of polymerase chain reaction (PCR) was compared with other testing methods used in the diagnosis of C. psittaci. Tissue and fecal specimens (n = 119) of avian and mammalian origin were tested by PCR and one or more of the following methods: cell culture, enzyme-linked immunosorbent assay, and direct fluorescein-conjugated monoclonal antibody staining. Several gold standards, based on results of testing methods other than PCR, were used to calculate the following test performance characteristics of PCR: sensitivity and specificity, with their 95% confidence intervals; kappa statistics, a measure of intertest agreement; and lambda statistics, a chance-corrected estimate of the sensitivity and specificity. Overall, the test performance characteristics of PCR were low compared with the other testing methods. Possible reasons for the poor test performance of PCR in the current study include destruction of the organisms during storage, interference with the PCR by other reagents, or technical errors.     

Detection of Chlamydia psittaci DNA in avian clinical samples by polymerase chain reaction

A polymerase chain reaction (PCR) assay was developed to detect Chlamydia psittaci DNA in faeces and tissue samples from avian species. Primers were designed to amplify a 264 bp product derived from part of the 5′ non-translated region and part of the coding region of the ompA gene which encodes the major outer membrane protein. Amplified sequences were confirmed by Southern hybridization using an internal probe. The sensitivity of the combined assay was found to be between 60 to 600 fg of chlamydial DNA (approximately 6 to 60 genome copies). The specificity of the assay was confirmed since PCR product was not obtained from samples containing several serotypes of C. trachomatis, strains of C. pneumoniae, the type strain of C. pecorum, nor from samples containing microorganisms commonly found in the avian gut flora. In this study, 404 avian faeces and 141 avian tissue samples received by the Central Veterinary Laboratory over a 6 month period were analysed by PCR, antigen detection ELISA and where possible, cell culture isolation. PCR performed favourably compared with ELISA and cell culture, or with ELISA alone. The PCR assay was especially suited to the detection of C. psittaci DNA in avian faeces samples. The test was also useful when applied to tissue samples from small contact birds associated with a case of human psittacosis where ELISA results were negative and chlamydial isolation was a less favourable method due to the need for rapid diagnosis.     

Analysis of caprine IgG1 and IgG2 subclass responses to Chlamydia psittaci infection and vaccination

Enzyme-linked immunosorbent assays (ELISAs) specific for caprine IgG(H+L), IgG1 and IgG2 were developed and evaluated for serodiagnosis of Chlamydia psittaci infections in a Tunisian goat flock with currently occurring chlamydial abortions and a clinically inapparent goat flock of an animal research facility. Additionally, ELISAs were applied to record the IgG1 and IgG2 dynamics of four goats vaccinated with inactivated Chlamydia psittaci and Coxiella burnetii. For screening purposes, the IgG(H+L) ELISA proved to be superior to the complement fixation test because it detected a larger number of chlamydial abortions and was easier to perform and to interpret. Analysis of Chlamydia psittaci-specific IgG1 and IgG2 responses to naturally occurring infections by ELISA revealed high IgG1 levels associated with IgG2 in goats with current abortions, whereas clinically inapparent, but seropositive goats were characterized by significantly lower IgG1 levels only (P less than 0.001). Similarly, the four vaccinated goats responded initially with Chlamydia psittaci-specific IgG1, whereas second and third vaccinations induced (as in goats with chlamydial abortions) predominantly IgG1, but also IgG2. The results indicated that clinically inapparent chlamydial infection may be distinguished from overt disease by analysing specific IgG1 and IgG2 responses. Applying Coxiella burnetii- specific ELISAs on field samples, IgG1 alone could be detected in eight, IgG2 alone in one and IgG1 combined with IgG2 in nine goats. The coxiella-specific antibody response of the four vaccinated goats was--in contrast to the chlamydia-specific response--characterized by IgG2 dominance.     

Seroprevalence of chlamydial infection in cattle in Ireland

Although few studies have investigated the prevalence of chlamydial infections in cattle, reported prevalence rates vary hugely. In order to assess the prevalence of this infection in cattle in Ireland, serum samples (100 herds, 20 samples/herd) collected for statutory screening for brucellosis were examined by soluble chlamydial antigen indirect ELISA. The assay detects antibodies to the two most common Chlamydiaceae spp. affecting cattle, namely Chlamydia abortus and Chlamydia pecorum. A total of 95 samples from 57 herds were seropositive, representing an observed prevalence rate of 4.75%. The parametric bootstrap estimate of the mean disease prevalence in the population was 6.04% (95%, CI 4.70-7.50). The results suggest the prevalence of chlamydial infection is low in cattle in Ireland.     

Proctitis associated with chlamydial infection in a koala

Objective To describe proctitis associated with chlamydial infection in a koala.
Design A pathological study  

Animal

A free living, male koala aged 17 years.
Procedure Rectum was examined histologically and chlamydial organisms visualised using Giminez stain and an immunoperoxidase staining method using an anti- Chlamydia lipopolysaccharide (genus specific) antibody.
Results An aged koala presented for euthanasia was found to have asymptomatic chronic proctitis, cystitis, prostatitis, urethritis and conjunctivitis associated with chlamydial infection. Inflammation was severe in the terminal rectum and extended into the proximal common vestibule. Chlamydial organisms were visualised in the rectal surface epithelium using Giminez stain and an immunoperoxidase staining method. Organisms were also detected in the epithelium of the bladder, prostate and urethra.  

Clinical Implications

Possible modes of transmission for the rectal infection are direct sexual transmission or ascending infection by organisms shed from the urogenital tract into the common vestibule. Previously unreported chlamydial proctitis in the koala may represent a potential reservoir of infection for other koalas.     

Comparison of milk and serum enzyme-linked immunosorbent assays for diagnosis of Mycobacterium avium subspecies paratuberculosis infection in dairy cattle.

Milk and serum samples from 35 dairy herds in 17 states were evaluated for cow- and herd-level Mycobacterium avium subspecies paratuberculosis (MAP) antibody test agreement. Evaluation of 6,349 samples suggested moderate agreement between milk and serum enzyme-linked immunosorbent assay (ELISA) results, with a kappa value of 0.50. Cow-level sensitivity (Se) for 18 dairy operations with 1,921 animals was evaluated relative to fecal culture results. At the cow level, the milk ELISA relative Se was not significantly different from that of the serum ELISA (21.2 and 23.5%, respectively). Logistic regression models revealed a positive association between lactation number and milk ELISA status. Non-Holstein cows were more likely to test milk ELISA positive than Holstein cows. Cows in the first 2 weeks of lactation and after week 45 of lactation were more likely to test milk ELISA positive than cows between 3 and 12 weeks of lactation. Milk production > 80% of herd average was negatively associated with testing milk ELISA positive. Animals in the West and Midwest regions were less likely than animals in the Southeast region to test ELISA positive by either test. Estimates for herd-level sensitivity for the milk and serum ELISA, relative to fecal culture results, ranged from 56 to 83%. At the cow and herd levels, milk ELISA performed equivalent to serum ELISA using fecal culture as a reference for MAP infection and has the advantage of decreased labor costs on farms that use Dairy Herd Improvement Association testing.     

The application of the soluble antigen fluorescent antibody test for the diagnosis of avian influenza.

The application of the soluble antigen fluorescent test as a tool for serological investigation of influenza type A infection in wild birds was studied. The soluble antigen fluorescent antibody test is basically an indirect fluorescent antibody test except that an artificial matrix of cellulose acetate discs is used as a substrate for antigen and the test results are scanned and recorded by a fluorometer. THe influenza type A soluble antigen fluorescent antibody was obtained from concentrated and detergent disrupted virus particles, absorbed onto cellulose acetate discs. Anti-influenza sera were prepared in pheasants and ducks to A/turkey/Ontario/6118/67 and in pigeons to A/turkey/Ontario/6213/68. The antigen-antibody complex was detected by specific staining with monovalent or polyvalent fluorescein isothiocyanate conjugated rabbit anti-avian immunoglobulins. The soluble antigen fluorescent antibody test is a sensitive technique for the detection of specific influenza A antibodies in several avian species, and could be adapted for use in large scale surveys.