Diagnosis of Chlamydia pneumoniae
Culture of clinical samples has been a disappointment. In cases verified by serology, the sensitivity of isolation has been about 50% [11, 12, 13, 14, 15, 16]. There could be several reasons for this result. The ideal cell line for C. pneumoniae isolation may not have been found. Circulating strains may vary considerably in their ability to grow in cell cultures, and serologic findings can depend on the method used and the population studied. As a rule, in primary isolations, only a few inclusions are found. There is a possibility that only a few C. pneumoniae elementary bodies (EBs) in the sample are able to induce an inclusion. Another possible explanation is that the true number of infecting EBs is initially low, leading to the small amount of C. pneumoniae organisms in throat epithelium samples collected by swabbing. This latter assumption is supported by the low sensitivity of other diagnostic methods based on the direct demonstration of the organism or its components in throat swabs. Nasopharyngeal swabs have been recommended in some studies  but others have not found them to be of any advantage  Pretreatment of samples has been recommended . The principal multiplication site of C. pneumoniae can be other than the superficial epithelium of the respiratory tract. When the pathogen invades deeper tissues, obtaining a proper sample can be more difficult. Since cough is usually non-productive, sputum samples are often difficult to obtain and thus induced sputa or bronchoalveolar lavages (BALs) are needed.
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