Blood tests for Chlamydia pneumoniae and Mycoplasma

I recently asked Dr. Hahn (July 2010) what his current thoughts are regarding blood testing. Here is what he had to say:

Regarding Cp testing, the bottom line is that we have been unable to find a test or set of tests that is a good predictor of who will respond positively to treatment, or not. We are still looking.

So I am still recommending that people with asthma base their decision on the severity of their asthma, whether conventional (guideline) treatment is effective, and other factors. For example:

1. Are the symptoms severe, unremitting, and resistant to treatment?
2. Did the asthma begin (perhaps recently) out of the blue - perhaps after a respiratory illness?
3. Are you the type of person who dislikes the idea of taking steroids - or has significant side effects - and would like to try unconventional treatment?
4. How will you know whether the treatment has worked, or not? Are your symptoms bad enough that you will recognize when (if) they get better or go away? If not, what other criteria will you use?

These are the questions I ask of people with asthma who ask about azithromycin treatment for their asthma.

Currently available tests are:

1. Serology: the microimmunofluorescence (MIF) test for IgG, IgA, and IgM remains the gold standard.
   
   Serology can be diagnostic for acute infections but is only suggestive for chronic infections. And sometimes people with documented infection by PCR (see below) can have negative serology.
   
   There are several commercial MIF kits available in Europe, and some American labs have their own MIF tests. I use Mayo labs but there are others. A different type of serological test is called ELISA but I don't have much direct experience with this type of test and personally prefer the MIF: even though it is more cumbersome and subjective, there is more empirical individual clinical validation for MIF than for ELISA.
2. Polymerase chain reaction (PCR) test:
   
   I am aware that some labs are offering this test. PCR detects the DNA of C. pneumoniae (and sometimes other Chlamydia).
   
   The PCR test can be positive in 10-50% of people without any obvious diseases, so again this test is suggestive, not diagnostic. i.e., just because someone is positive doesn't prove that the chlamydia is causing the asthma, although it might be so.
3. Chlamydia-specific IgE: this is an interesting development that is not available commercially but that appears promising in research settings.
   
   IgE is the "allergic antibody" that your allergist will test for if he or she draws your blood to see if you are "allergic" to things like dust mite(-speficic IgE) etc.
   
   Not everyone who has allergen-specific (like dust mite) IgE will actually have allergic symptoms to dust, so even this test is more suggestive than diagnostic (despite what your allergist might be telling you).
   
   Chlamydia-specific IgE appears to be common in people of all ages with asthma, so this is just another indication of a possible causal association - i.e., that this chronic bacterial infection might create asthma via an allergic mechanism.

Other researchers are considering looking into novel ways of diagnosing deep lung infection by C. pneumoniae: by analyzing breath samples for various compounds that might indicate infection, for example.

The basic problem is with SAMPLING: it is possible (likely, in my opinion) that the chlamydia may be active only in scattered areas deep in the lung - in immune cells called "dendritic cells" for example - and this scattered infection might be able to cause enough immunologic mischief there to create asthma throughout the whole lung (there is in fact excellent evidence from animal experiments to suggest that this is so).

If this is the case, the samples from the breath, or even from the bronchial tree itself could be negative even though the lung is infected.

And I haven't yet met anyone with asthma who is willing to donate a lung in the search for C. pneumoniae!

In case you're interested in the bloodtest Jim took in 1996

A lot of new techniques have no doubt occurred in lab testing since I was tested in 1996.  The following information is about the tests I took and about several labs I found on the internet that will test for Chlamydia pneumoniae.

The type of blood test I received in 1996 was a Chlamydia pneumoniae AB Panel and is used to test for antibody's in your blood.  The presence of antibody's in your blood means that your body was fighting this bacteria at one time.  I took the test at Corning Clinical Laboratory in Tampa and they sent it to MRL Laboratory in Cypress California (in 1996) for processing.  

However, the modern tests for Chlamydia pneumoniae are now the PCR tests

PCR (Polymerase Chain Reaction)

>We currently have no recommended testing facilities. However google search seems to find many references.

My test results:
My blood test was NOT a PCR blood test as this was done in 1996 using an older type test-AB Panel. So this may not be relevant to your case.

Interpretation:  Infection by chlamydia pneumoniae at an undetermined time

The following information was delivered and copied by me from the yahoo cfs-mycoplasma group. I'm not an expert in this area so use this information as required.

• TYPES OF MYCOPLASMA TESTS

1. INDIVIDUAL: The most accurate of the PCR blood tests is the individual test for a specific species.

2. "MULTIPLEX": Multi-species ("3 in 1" or "4 in 1") mycoplasma PCR blood tests are less expensive but their accuracy rate may not be as high as individual species tests. Therefore, patients need to specifically ask
the laboratories for the published accuracy rate of their "multiplex" tests. Additionally, some laboratories identify a combination of tests for one price as a "panel" when in fact they are performing a "multiplex"
test.

3. ANTIBODY TEST: The least accurate of the blood tests. In the case of Mycoplasma fermentans (incognitus), antibodies are not produced until the patient is near death. However, antibodies to the other mycoplasma species are produced more readily.

4. CULTURE: Mycoplasmas are rarely successfully cultured, as they require specialized culture mediums and weeks of careful laboratory work. In some rare instances, culturing may be an alternative choice.

* * *

• Recommendations - "HOW TO GET AN ACCURATE POLYMERASE CHAIN REACTION (PCR)BLOOD TEST FOR MYCOPLASMAS"

— Do not perform the General (or Family) Mycoplasma species screening test. It is not as accurate as hoped. This test should never be used by physicians as a screening test for mycoplasmal infections in patients.

— Have the blood drawn at the testing lab. If that is impractical, the second best solution is to have the blood delivered to the lab within 24 hours. Blood samples left at room temperature for longer than
24 hours cause half the mycoplasmas to die and disintegrate. After 72 hours at room temperature all the mycoplasmas will have died and disintegrated. Once they disintegrate, the specific genetic sequences
needed for PCR amplification will have vanished, resulting in a false negative.

— Have the blood sample drawn later in the day if you are shipping overnight. This shortens the hours before the sample is processed. Also, have the blood drawn early in the week rather than on a Friday
so that the sample arrives on a day when the lab is open, rather than sitting unprocessed over the weekend.

— Ship blood samples with small packs of blue ice which keeps the sample at a refrigerated temperature (not frozen). Place some packing material between the blood sample and the blue ice to prevent the blood from
freezing, which causes coagulation, ruining the sample for testing.

— Do not take any antibiotics at least one month or longer before a PCR blood test. The antibiotics will remove most of the infection from the blood, reducing the chances of amplifying the specific genetic
sequences needed for an accurate result.

— Do not take vitamins, herbs or supplements that boost the immune system and/or kill mycoplasmas. Examples would be colloidal silver, flax seed oil, fish oils, vitamin C, IP6, immune boosters, garlic, transfer factor, olive leaf extract, etc. Unfortunately, no research exists to guide patients on how long they should avoid these products before drawing blood.

— The best time to have blood drawn is when the patient is symptomatic. Mycoplasmas can become dormant from time to time, so if a patient is feeling well it might not be the best time to test.

— If patients receive a negative result, but are still symptomatic, they should consider being retested. Review our recommended testing procedures to see if they were followed correctly. Discuss the merits
of retesting with your physician.

— Patients should never begin antibiotic treatment before being tested for a mycoplasmal infection. Some patients start antibiotics before being tested to see if they will show improvement. If they improve, they often refuse to stop using antibiotics before taking a PCR test due to relapses. Unfortunately, once antibiotics are started, the risk increases for getting a false PCR result, even if the patient stops
taking antibiotics later. This leaves patients unsure of their exact infection, preventing them from taking the most effective antibiotic. Without a positive test result, physicians often refuse to prescribe long term antibiotics.

— Antibody Tests may be an alternative to PCR for patients already on antibiotics. Although traditional antibody tests are generally not as accurate as PCR, detection may be possible if a patient has developed
mycoplasma antibodies.

• LABORATORIES TESTING FOR MYCOPLASMA & CO-INFECTIONS

Medical Diagnostic Laboratories
133 Gaither Drive, Suite C
Mt. Laurel, New Jersey 08054
Toll-free: 877.269.0090
Tel: 609.608.1696
Fax: 609.608.1667
Email: mailto:SALES@MDLAB.COM
Website: http://www.mdlab.com

The Arthritis Research Center
504 E. Diamond Avenue
Suite I Gaithersburg, Maryland 20877
Tel: 301.216.1231
Fax: 301.216.0302
(Mycoplasma PCR and Antibody tests)

Quest Diagnostics Incorporated
One Malcolm Ave.
Teterboro, New Jersey 07608
Toll-free 800.222.0446
Tel: 201.393.5000
Fax: 201.462.4715
Website: http://www.questdiagnostics.com/index.html
Mycoplasma:
http://cas2.questdiagnostics.com/scripts/dos.wls?wlapp=DOS

Laboratory Corporation of America Holdings (LH)
358 S. Main St.
Burlington, North Carolina 27215
Tel: 336.584.5171
Fax: 336.436.1205
Website: http://www.labcorp.com/

Specialty Laboratories, Inc.
2211 Michigan Ave.
Santa Monica, California 90404-3900
Toll-free: 800.421.4449
Tel: 310.828.6543
Fax: 310.586.7275
Email: mailto:specialty@specialtylabs.com
Website: http://www.specialtylabs.com/main.html
Mycoplasma tests:
http://www.specialtylabs.com/tests/display.asp?catID=&keyword=mycoplasma&
searchtype=tests

Esoterix Infectious Disease Center
7540 Louis Pasteur Dr # 202
San Antonio, Texas 78229
Toll-free: 800.299.7350 or 800.661.4118
Toll-free: Client Services: 800.383.0980
Tel: 210.614.7350, 210.614.7350
Fax: 201.692.1411, 210.614.7355
Website: http://www.esoterix.com

IGeneX Inc.
797 San Antonio Road
Palo Alto, California 94303
Toll-free: 800.832.3200
Tel: 650.424.1191
Fax: 650.424.1196
Email: mailto:igenex@igenex.com
Website: http://www.igenex.com

ViraCor
1210 NE Windsor Drive
Lee's Summit, MO 64086
Toll-free: 800.305.5198
Fax: 816.347.0143
Email: mailto:info@ViraCor.com
Website: http://www.viracor.com

Europe

R.E.D. LABORATORIES
Pontbeek 61
B-1731 Zellik,Belgium
Tel: 32-2-481-5310
Fax: 32-2-481-5311
Email: mailto:info@redlabs.com
Website: http://www.redlabs.com

Pro Health Laboratorium
Schoutlaan 4a
6002 EA Weert
The Netherlands
Tel: (31)(0)495 545000
Fax: (31)(0)495 550722
E-mail: mailto:lab@prohealth.nl

Micropathology Ltd.
University of Warwick Science Park
Barclays Venture Centre
Sir William Lyons Road Coventry CV4 7EZ, United Kingdom
Tel: +44-(0)-24-76-323222
Fax: +44-(0)-24-76-323333
Email: mailto:info@micropathology.com
Website: http://www.micropathology.com

Nutri-Link Ltd.
8A Powderham Road
Newton Abbot, Devon
TQ12 1EU, England
Tel: +44-(0)-16-26-205417
Fax: +44-(0)-16-26-205418
[U.K. representative of Immunosciences Lab., Inc.
Sends blood to Beverly Hills, CA USA]

Australia

Australian Biologics Testing Services
6th Floor Fayworth House
383 Pitt Street
Sydney NSW 2000, Australia
Tel: 61-2-9283-0807
Fax: 61-2-9283-0910
E-mail: mailto:austbio@mpx.com.au