Laboratory diagnosis ofMycoplasma pneumoniaeinfection: 2. Comparison of methods for the direct detection of specific antigen or nucleic acid sequences in respiratory exudates
SUMMARYThe efficiency of the direct detection ofMycoplasma pneumoniaein respiratory exudates by an antigen capture, indirect enzyme immunoassay (Ag-EIA), has been compared with its detection with a cDNA probe (‘Gen-Probe assay’) directed against the specific ribosomal RNA sequences of the organism (‘Mycoplasma pneumoniaeRapid Diagnostic System’, Gen-Probe, San Diego, California).Both assays showed excellent specificity against a range of mycoplasma species suspended in negative nasopharyngeal aspirates; onlyM. pneumoniaeandM. genitaliumreacted. In experiments with graded doses of viableM. pneumoniaecells suspended in negative nasopharyngeal aspirate, the Gen-Probe assay was more sensitive than Ag-EIA; detection limits were respectively 2 × 103 c.f.u./ml (3·2 × 105genomes) and 2·5 × 104c.f.u./ml (4 × 106genomes); detection levels 10–100 times less sensitive than culture.The two assays were also tested on nasopharyngeal aspirates or sputum specimens from 90 patients with respiratory infection; 67 of these were culture-or seronegative forM. pneumoniaeand 23 were culture-or seropositive. Ag-EIA detected 21 (91%) of the latter but the Gen-Probe assay detected only 5 (22%). Both assays were negative with the 67 culture-/sero-negatives; there were no Gen-Probe assay positive/Ag-EIA negatives.Overall, it is concluded that although Ag-EIA and the Gen-Probe assay are effective substitutes for culture as a diagnostic procedure, there is a significant problem with samples which are culture-negative and from patients who have good serological evidence of current infection. Possible reasons for the disparity between the two assays are advanced.