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The case presented is remarkable, and the analysis very thorough.
However, the case would be stronger if a diagnosis in the mother was
obtained. Chlamydia serology might very well contribute to this - a
possibility that seems to have been overlooked. Generally serology is NOT
useful in the diagnosis of acute infection, because 1) uncomplicated lower
genital tract infections often don't result in elevated titres, 2)
serologically it's difficult to distinguish present from prior infection*.
If CT infection is spread to the upper genital tract (resulting in
clinical or subclinical endometritis/salpingitis), an antibody response is
usually measurable. After a pelvic inflammatory disease (PID) episod,
chlamydial antibodies persist for a long time**, making it worth trying to
obtain as yet a serodiagnosis in this case. In fact serology might also
have been useful in the initial working up of the woman's infertility
problem. If the history and clinical features are very suggestive for CT
infection, on should not be satisfied with a negative endocervical enzyme
immunoassay – the sensitivity of this test is rather low***.
*Puolakkainen M, Vesterinen E, Persistence of chlamydial antibodies
after pelvic inflammatory disease. J Clin Microbiol 1986;23(5):924-8.
**Black CM, Current methods of laboratory diagnosis of Chlamydia
trachomatis infections. Clin Microbiol Rev 1997;10(1):160-84
***Van Dyck E, Ieven M, Detection of Chlamydia trachomatis and Neisseria
gonorrhoeae by Enzyme Immunoassay, Culture, and Three Nucleic Acid
Amplification tests. J Clin Microbiol 2001;39(5):1751-6
serology might be useful
The case presented is remarkable, and the analysis very thorough.
However, the case would be stronger if a diagnosis in the mother was
obtained. Chlamydia serology might very well contribute to this - a
possibility that seems to have been overlooked. Generally serology is NOT
useful in the diagnosis of acute infection, because 1) uncomplicated lower
genital tract infections often don't result in elevated titres, 2)
serologically it's difficult to distinguish present from prior infection*.
If CT infection is spread to the upper genital tract (resulting in
clinical or subclinical endometritis/salpingitis), an antibody response is
usually measurable. After a pelvic inflammatory disease (PID) episod,
chlamydial antibodies persist for a long time**, making it worth trying to
obtain as yet a serodiagnosis in this case. In fact serology might also
have been useful in the initial working up of the woman's infertility
problem. If the history and clinical features are very suggestive for CT
infection, on should not be satisfied with a negative endocervical enzyme
immunoassay – the sensitivity of this test is rather low***.
*Puolakkainen M, Vesterinen E, Persistence of chlamydial antibodies
after pelvic inflammatory disease. J Clin Microbiol 1986;23(5):924-8.
**Black CM, Current methods of laboratory diagnosis of Chlamydia
trachomatis infections. Clin Microbiol Rev 1997;10(1):160-84
***Van Dyck E, Ieven M, Detection of Chlamydia trachomatis and Neisseria
gonorrhoeae by Enzyme Immunoassay, Culture, and Three Nucleic Acid
Amplification tests. J Clin Microbiol 2001;39(5):1751-6
Competing interests: No competing interests