Accuracy of two enzyme immunoassays and cell culture in the detection ofChlamydia trachomatis in low and high risk populations in senegal |
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| Authors: | E Van Dyck N Samb A Dieng Sarr L Van de Velden J Moran S Mboup I Ndoye J L Lamboray A Meheus P Piot |
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| Institution: | (1) Department of Microbiology, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium;(2) Laboratory of Bacteriology and Virology, Hôpital Aristide Le Dantec, Dakar, Senegal;(3) Projet Pikine, Coopération Médicale Belge, Dakar, Senega;(4) National Center for Prevention Services, Centers for Disease Control, Atlanta, Georgia, USA;(5) Bureau National des MST, Dakar, Senegal;(6) The World Bank, Washington, DC, USA;(7) STD/VTD Programme, World Health Organisation, Geneva, Switzerland |
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| Abstract: | Two enzyme immunoassays (EIAs), Chlamydiazyme (CZ; Abbott Laboratories) and Pathfinder (PF; Kallestadt), were compared with a cell culture technique in the detection of cervicalChlamydia trachomatis infection in 670 women in urban settings in Senegal (377 pregnant women and 293 prostitutes). Positive CZ and positive PF specimens were tested a second time using a monoclonal antibody blocking technique. True positive specimens were defined as those positive on culture or positive on EIA with confirmation of the result after blocking. Using this definition, the prevalence of genital chlamydial infection was 14.6 % and 14.3 % in pregnant women and prostitutes respectively. An important difference between the two populations was that the pregnant women were younger than the prostitutes, which might explain the fact that the prevalence of infection among the pregnant women was as high as that among the prostitutes, although the age-adjusted prevalence was higher among prostitutes than among pregnant women. The chlamydial detection rates of cell culture, CZ and PF were 62 % (26/42), 69 % (29/42) and 86 % (36/42) respectively in prostitutes and 76 % (42/55), 40 % (22/55) and 53 % (29/55) respectively in pregnant women. Agreement between the tests was 89 %, 85 % and 88 % for culture/CZ, culture/PF and CZ/PF respectively. However, when data were adjusted for chance agreement, kappa coefficients were 0.40 for culture/CZ, 0.34 for culture/PF and 0.48 for CZ/PF. These results indicate that the accuracy of the EIAs and cell culture may vary greatly in different populations: both EIAs showed a distinctly higher detection rate than culture in prostitutes and a significantly lower detection rate in pregnant women. Confirmation of positive EIA results with a blocking assay greatly enhanced the specificity of the antigen detection tests and should be obtained when using the EIAs in a clinical setting. |
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