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Infantile chlamydial conjunctivitis. A comparison of Papanicolaou, Giemsa and immunoperoxidase staining methods
Insights
Diagnosing infantile Chlamydia trachomatis conjunctivitis has risen significantly. This study compared Papanicolaou and Giemsa staining with immunostaining, finding routine stains accurate but immunostaining more sensitive for detecting this infection.
Area of Science:
- Ophthalmology
- Microbiology
- Infectious Diseases
Background:
- Infantile Chlamydia trachomatis conjunctivitis diagnosis via conjunctival smears increased significantly between 1979 and 1984.
- A need exists to evaluate diagnostic methods for accuracy and sensitivity.
Purpose of the Study:
- To compare the diagnostic accuracy of Papanicolaou and Giemsa staining with an avidin-biotin immunostaining technique for infantile Chlamydia trachomatis conjunctivitis.
- To assess the sensitivity and specificity of routine staining methods against a monoclonal antibody-based immunoperoxidase method.
Main Methods:
- Retrospective review of 33 infant conjunctival smear slides.
- Comparison of Papanicolaou and Giemsa staining with direct immunostaining using an antichlamydial monoclonal antibody.
- Destaining and subsequent immunostaining of Papanicolaou slides.
Main Results:
- Chlamydial infection was diagnosed in 61% of Papanicolaou-stained and 64% of Giemsa-stained slides.
- Immunostaining of destained Papanicolaou slides identified infection in 79% of cases.
- Papanicolaou staining sensitivity: 73%, specificity: 86%. Giemsa staining sensitivity: 77%, specificity: 100% compared to immunoperoxidase.
Conclusions:
- The immunoperoxidase method is applicable and highly sensitive for diagnosing Chlamydia trachomatis conjunctivitis.
- Routine Papanicolaou and Giemsa stains are accurate but less sensitive than immunostaining.
- The incidence of chlamydial conjunctivitis in the hospital population is increasing.
Abstract:
The use of conjunctival smears to diagnose infantile Chlamydia trachomatis infection increased sixteen-fold in our hospital between the years 1979 and 1984. The present study was conducted to compare Papanicolaou and Giemsa staining methods with the avidin-biotin technique of immunostaining utilizing a highly specific antichlamydial monoclonal antibody. On retrospective review of 33 patients, chlamydial infection was diagnosed in 61% of the Papanicolaou-stained and 64% of the Giemsa-stained slides. After the Papanicolaou-stained slides were destained and immunostained with the antichlamydial antibody, round particles corresponding in size to elementary and reticulate bodies were readily seen in 79% of the cases. In comparison with the immunoperoxidase method, the sensitivity and specificity of Papanicolaou staining were 73% and 86%, respectively, while the corresponding figures for Giemsa staining were 77% and 100%, respectively. The study established the applicability of the immunoperoxidase method to this clinical condition, confirmed the accuracy of diagnoses with routine stains and highlighted the increasing incidence of chlamydial conjunctivitis in our hospital population.