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Polymerase chain reaction shows advantage for diagnosing neonatal chlamydial conjunctivitis

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Polymerase chain reaction appears to demonstrate a higher sensitivity and similar specificity compared to conventional methods of diagnosing chlamydial conjunctivitis in infants, according to a study by researchers in China. In addition, this testing method has an advantage over conventional methods for diagnosing milder forms of the disease.

"It is important to note that a higher inhibition rate in the polymerase chain reaction test was observed in neonatal conjunctivitis specimens and caution should be used when interpreting the results," the study authors said in the July/August issue of Journal of Pediatric Ophthalmology & Strabismus.

Pui-pui Yip, MRCS, MMedSc, and colleagues at Tuen Mun Hospital in Hong Kong compared polymerase chain reaction, cell culture and direct immunofluorescent assay for diagnosing neonatal chlamydial conjunctivitis in 368 eyes of 184 infants. Specifically, the investigators graded all eyes according to conjunctivitis severity; neonatal chlamydial conjunctivitis was diagnosed if one of the three tests was positive and a clinical improvement could be observed after treatment.

Thirty-two eyes of 24 infants were diagnosed as having chlamydial infection; of these eyes, conjunctival specimens in 30 eyes (93.8%) showed positive results for polymerase chain reaction, and specimens in 23 eyes (71.9%) showed positive results for each of the conventional methods.

The researchers then used the positive results of either the cell culture or direct immunofluorescent assay as a standard for diagnosing neonatal chlamydial conjunctivitis. "The sensitivity and specificity of polymerase chain reaction were 92% and 97.7%, respectively," they said.

However, the sensitivity and specificity for cell cultures using polymerase chain reaction as the standard for diagnosing the condition were 73.3% and 99.7%, respectively, the authors noted.

"A discrepancy was noted in the number of positive results between polymerase chain reaction and conventional methods in milder disease," the authors said.