Lymphogranuloma venereum laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Lymphogranuloma venereum}} | {{Lymphogranuloma venereum}} | ||
{{CMG}}; {{AE}} {{NRM}} | {{CMG}}; {{AE}} {{NRM}}, {{AA}} | ||
==Overview== | ==Overview== | ||
Because of limitations in | 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 | *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''. | *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|Serologic]] tests of [[rectal]] [[mucosa]] swabs from patients with [[proctitis]] are insensitive. | ||
*Serology is only genus specific. | *Serology is only genus specific. | ||
*Cross-reactivity with other species is possible.<ref name="Mabey2002" | *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. | *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> | *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> | ||
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===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). | *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 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">< | *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== | |||
Persons who receive an LGV diagnosis should be tested for other STDs, especially [[HIV]], [[gonorrhea]], and [[syphilis]].<ref name="CDCLGV"></ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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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
- Compliment fixation and immunofluorescence tests of lesion swab or bubo aspirate can be used to detect C. trachomatis.
- 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
- ↑ 1.0 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.
- ↑ 2.0 2.1 Mabey, D (2002). "Lymphogranuloma venereum". Sexually Transmitted Infections. 78 (2): 90–92. doi:10.1136/sti.78.2.90. ISSN 1368-4973.
- ↑ 3.0 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.
- ↑ http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/chlamydia-and-gonorrhea-screening Accessed on Sep 8, 2016