Comparison of diagnostic techniques for porcine proliferative enteropathy (Lawsonia intracellularis infection)

In studying the post-mortem diagnosis of porcine proliferative enteropathy (PPE) a "double-blind" study was performed on 77 apparently healthy "finisher" pigs at the time of slaughter, to compare the results of a polymerase chain reaction (PCR) technique with those of (1) an indirect immunofluorescence assay (IFA), (2) examination for gross proliferative lesions at slaughter, (3) histopathological study of sections stained with haematoxylin and eosin (HE), and (4) Warthin-Starry (WS) silver staining for intracellular bacteria. The IFA, with a sensitivity of 89% and a specificity of 97% (positive "likelihood ratio"=30) and an agreement of 82% with PCR, is suggested as an alternative to the PCR in the post-mortem diagnosis of PPE. Histopathological examination was shown to be of little use as a principal diagnostic method, although it appeared to be effective in diagnosing infection by Lawsonia intracellularis in cases with proliferative-type lesions (positive likelihood ratio=29.6). Finally, the values obtained from an examination of gross lesions (k=0.075; positive likelihood ratio of 1.3) and WS staining (k=0.42; positive likelihood ratio of 5.3) demonstrated the lack of validity of these tests for the diagnosis of L. intracellularis infection.