Lymphogranuloma venereum laboratory findings: Difference between revisions

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{{Lymphogranuloma venereum}}
{{Lymphogranuloma venereum}}
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==Overview==
==Overview==
Because of limitations in a commercially available test, diagnosis is primarily based on clinical findings. Direct identification of the bacteria from a lesion or site of the infection may be possible through testing for [[chlamydia]] but, this would not indicate if the chlamydia infection is LGV. However, the usual chlamydia tests that are available have not been FDA approved for testing rectal specimens. In a patient with rectal signs or symptoms suspicious for LGV, a health care provider can collect a specimen and send the sample to his/her state health department for referral to CDC, which is working with state and local health departments to test specimens and validate diagnostic methods for LGV.
Because of limitations in commercially available tests, clinical presentation, in conjunction to laboratory findings, plays an important role in diagnosis. ''C. trachomatis'' can be identified from lesion swabs, [[bubo]] [[aspirate]], or [[rectal]] [[mucosa]] swabs (in patients with [[proctitis]]) using culture methods, [[Serology|serologic]] testing, and nucleic acid amplification tests (NAATs). Culture is impractical since it is time consuming and lacks sensitivity. Compliment fixation and [[immunofluorescence]] serologic tests are sensitive but only genus specific. NAATs are the most reliable method for detecting ''C. trachomatis'' and real-time [[Polymerase Chain Reaction|PCR]] can detect the LGV-specific [[serovar]].


==Laboratory Findings==
==Laboratory Findings==
===Culture===
===Culture===
*Primary lesion swabs or [[bubo]] aspirate can be cultured on cyclohexamide-treated McCoy or [[HeLa]] cells.
*Primary lesion swabs or [[bubo]] [[aspirate]] can be cultured on cyclohexamide-treated McCoy or [[HeLa]] cells.
*Sensitivity is approximately 75% - 85%.<ref name="pmid25870512">{{cite journal| author=Ceovic R, Gulin SJ| title=Lymphogranuloma venereum: diagnostic and treatment challenges. | journal=Infect Drug Resist | year= 2015 | volume= 8 | issue=  | pages= 39-47 | pmid=25870512 | doi=10.2147/IDR.S57540 | pmc=PMC4381887 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25870512  }} </ref>
*Sensitivity is approximately 75% - 85%.<ref name="pmid25870512">{{cite journal| author=Ceovic R, Gulin SJ| title=Lymphogranuloma venereum: diagnostic and treatment challenges. | journal=Infect Drug Resist | year= 2015 | volume= 8 | issue=  | pages= 39-47 | pmid=25870512 | doi=10.2147/IDR.S57540 | pmc=PMC4381887 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25870512  }} </ref>
*Culture is impractical due to its time-consuming nature, the fact that it's not readily available and the test yields isolate only 30% of the time.<ref name="Mabey2002">{{cite journal|last1=Mabey|first1=D|title=Lymphogranuloma venereum|journal=Sexually Transmitted Infections|volume=78|issue=2|year=2002|pages=90–92|issn=13684973|doi=10.1136/sti.78.2.90}}</ref>
*Culture is impractical due to its time-consuming nature, the fact that it's not readily available, and the test yields isolate only 30% of the time.<ref name="Mabey2002">{{cite journal|last1=Mabey|first1=D|title=Lymphogranuloma venereum|journal=Sexually Transmitted Infections|volume=78|issue=2|year=2002|pages=90–92|issn=13684973|doi=10.1136/sti.78.2.90}}</ref>


===Serology===
===Serology===
 
*Compliment fixation and [[immunofluorescence]] tests of lesion swab or [[bubo]] [[aspirate]] can be used to detect ''C. trachomatis''.
:*[[Serology|Serologic]] tests of [[rectal]] [[mucosa]] swabs from patients with [[proctitis]] are insensitive.
*Serology is only genus specific.
*Cross-reactivity with other species is possible.<ref name="Mabey2002" />
*A complement fixation titer of >1:64 with appropriate clinical presentation is suggestive of LGV.
*An immunofluorescence titer of >1:256 with appropriate clinical presentation is suggestive of LGV.<ref name="CDCLGV">2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (June 4, 2015). http://www.cdc.gov/std/tg2015/lgv.htm Accessed February 25, 2016.</ref>


===Nucleic Acid Amplification Tests (NAATs)===
===Nucleic Acid Amplification Tests (NAATs)===
*Lesion swabs, [[bubo]] aspirate, or [[rectal]] [[mucosa]] swabs can be tested for ''C. trachomatis'' using nucleic acid amplification tests (NAATs).
*NAATs have high specificity and sensitivity for ''C. trachomatis''.<ref name="pmid25870512" />
*NAATs performed on rectal specimens are not approved by the FDA but appear more accurate than other testing methods and are the preferred approach.<ref name="CDCLGV" /><ref>http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/chlamydia-and-gonorrhea-screening Accessed on Sep 8, 2016</ref>
*A [[biovar]]-specific [[polymerase chain reaction]] (PCR) test has been developed to detect the L-type [[serovars]] of LGV ''C. trachomatis''.<ref name="pmid25870512" />


 
==Other Laboratory Tests==
===Polymerase Chain Reaction===
Persons who receive an LGV diagnosis should be tested for other STDs, especially [[HIV]], [[gonorrhea]], and [[syphilis]].<ref name="CDCLGV"></ref>
 
* The [[diagnosis]] usually is made [[Serology|serologically]] (through [[complement fixation]]) and by exclusion of other causes of [[inguinal]] [[lymphadenopathy]] or [[genital]] [[ulcer]]s.  [[Serologic]] testing has a [[sensitivity]] of 80% after 2 weeks. Serologic testing may not be specific for [[serotype]] (has some cross reactivity with other chlamydia species) and can suggest LGV from other forms because of their difference in dilution, 1:64 more likely to be LGV and lower than 1:16 is likely to be other chlamydia forms. For identification of serotypes, culture is often used. Culture is difficult. Requiring a special media, [[cycloheximide]]-treated [[McCoy]] or [[HeLa]] cells, and yields are still only 30-50%.
* DFA, or [[direct fluorescent antibody]] test, PCR of likely infected areas and pus, are also sometimes used.
** DFA test for the L-type serovar of C.trachomatis is the most sensitive and specific test, but is not readily available.
** If [[polymerase chain reaction]] (PCR) tests on infected material are positive, subsequent [[restriction endonuclease]] pattern analysis of the amplified outer membrane protein A gene can be done to determine the genotype. Recently a fast real time PCR (Taqman analysis) has been developed to diagnose LGV. With this method an accurate diagnosis is feasible within a day. It has been noted that one type of testing may not be thorough enough.<ref name="Workowski-2010">{{Cite journal  | last1 = Workowski | first1 = KA. | last2 = Berman | first2 = S. | last3 = Workowski | first3 = KA. | last4 = Bauer | first4 = H. | last5 = Bachman | first5 = L. | last6 = Burstein | first6 = G. | last7 = Eckert | first7 = L. | last8 = Geisler | first8 = WM. | last9 = Ghanem | first9 = K. | title = Sexually transmitted diseases treatment guidelines, 2010. | journal = MMWR Recomm Rep | volume = 59 | issue = RR-12 | pages = 1-110 | month = Dec | year = 2010 | doi =  | PMID = 21160459 }}</ref>
 
==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 17:59, 18 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A., Aysha Anwar, M.B.B.S[2]

Overview

Because of limitations in commercially available tests, clinical presentation, in conjunction to laboratory findings, plays an important role in diagnosis. C. trachomatis can be identified from lesion swabs, bubo aspirate, or rectal mucosa swabs (in patients with proctitis) using culture methods, serologic testing, and nucleic acid amplification tests (NAATs). Culture is impractical since it is time consuming and lacks sensitivity. Compliment fixation and immunofluorescence serologic tests are sensitive but only genus specific. NAATs are the most reliable method for detecting C. trachomatis and real-time PCR can detect the LGV-specific serovar.

Laboratory Findings

Culture

  • Primary lesion swabs or bubo aspirate can be cultured on cyclohexamide-treated McCoy or HeLa cells.
  • Sensitivity is approximately 75% - 85%.[1]
  • Culture is impractical due to its time-consuming nature, the fact that it's not readily available, and the test yields isolate only 30% of the time.[2]

Serology

  • Serology is only genus specific.
  • Cross-reactivity with other species is possible.[2]
  • A complement fixation titer of >1:64 with appropriate clinical presentation is suggestive of LGV.
  • An immunofluorescence titer of >1:256 with appropriate clinical presentation is suggestive of LGV.[3]

Nucleic Acid Amplification Tests (NAATs)

  • Lesion swabs, bubo aspirate, or rectal mucosa swabs can be tested for C. trachomatis using nucleic acid amplification tests (NAATs).
  • NAATs have high specificity and sensitivity for C. trachomatis.[1]
  • NAATs performed on rectal specimens are not approved by the FDA but appear more accurate than other testing methods and are the preferred approach.[3][4]
  • A biovar-specific polymerase chain reaction (PCR) test has been developed to detect the L-type serovars of LGV C. trachomatis.[1]

Other Laboratory Tests

Persons who receive an LGV diagnosis should be tested for other STDs, especially HIV, gonorrhea, and syphilis.[3]

References

  1. ↑ 1.0 1.1 1.2 Ceovic R, Gulin SJ (2015). "Lymphogranuloma venereum: diagnostic and treatment challenges". Infect Drug Resist. 8: 39–47. doi:10.2147/IDR.S57540. PMC 4381887. PMID 25870512.
  2. ↑ 2.0 2.1 Mabey, D (2002). "Lymphogranuloma venereum". Sexually Transmitted Infections. 78 (2): 90–92. doi:10.1136/sti.78.2.90. ISSN 1368-4973.
  3. ↑ 3.0 3.1 3.2 2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (June 4, 2015). http://www.cdc.gov/std/tg2015/lgv.htm Accessed February 25, 2016.
  4. ↑ http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/chlamydia-and-gonorrhea-screening Accessed on Sep 8, 2016

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