Chlamydia Group Antibody, IgG and IgM

Synonym/acronym: N/A.

Common use

To diagnose some of the more common chlamydia infections such as community-acquired pneumonia transmitted by C. pneumoniae and chlamydia disease that is sexually transmitted by Chlamydia trachomatis.

Specimen

Serum (1 mL) collected in a red-top tube. Place separated serum into a standard transport tube within 2 hr of collection.

Normal findings

(Method: Enzyme immunofluorescent assay)

IgG	IgM
Less than 1:64	Less than 1:20

Description

Chlamydia, one of the most common sexually transmitted diseases, is caused by Chlamydia trachomatis. These gram-negative bacteria are called obligate cell parasites because they require living cells for growth. There are three serotypes of C. trachomatis. One group causes lymphogranuloma venereum, with symptoms of the first phase of the disease appearing 2 to 6 wk after infection; another causes a genital tract infection different from lymphogranuloma venereum, in which symptoms in men appear 7 to 28 days after intercourse (women are generally asymptomatic); and the third causes the ocular disease trachoma (incubation period, 7 to 10 days). C. psittaci is the cause of psittacosis in birds and humans. It is increasing in prevalence as a pathogen responsible for other significant diseases of the respiratory system. The incubation period for C. psittaci infections in humans is 7 to 15 days and is followed by chills, fever, and a persistent nonproductive cough. C. psittaci is a common cause of community-acquired pneumonia. It is also less commonly associated with meningoencephalitis, arthritis, myocarditis, and Guillain-Barré syndrome.

Chlamydia is difficult to culture and grow, so antibody testing has become the technology of choice. A limitation of antibody screening is that positive results may not distinguish past from current infection. The antigen used in many screening kits is not species specific and can confirm only the presence of Chlamydia species. Newer technology using nucleic acid amplification and DNA probes can identify the species. Assays that can specifically identify C. trachomatis require special collection and transport kits. They also have specific collection instructions, and the specimens are collected on swabs. The laboratory performing this testing should be consulted before specimen collection. Culture or liquid based PAP test may also be requested for identification of chlamydia.

This procedure is contraindicated for

N/A

Indications

Establish Chlamydia as the cause of atypical pneumonia
Establish the presence of chlamydial infection

Potential diagnosis

Positive findings in:

Chlamydial infection
Community-acquired pneumonia
Infantile pneumonia (related to transmission at birth from an infected mother)
Infertility (related to scarring of ovaries or fallopian tubes from untreated chlamydial infection)
Lymphogranuloma venereum
Ophthalmia neonatorum (related to transmission at birth from an infected mother)
Pelvic inflammatory disease
Urethritis

Critical findings

N/A

Interfering factors

Hemolysis or lipemia may interfere with analysis.
Positive results may demonstrate evidence of past infection and not necessarily indicate current infection.

Nursing Implications and Procedure

Potential nursing problems

Problem	Signs & Symptoms	Interventions
Infection (Related to exposure to bacterial organisms)	Temperature; increased heart rate; increased blood pressure; shaking; chills; mottled skin; lethargy; fatigue; swelling; elevated white blood cell (WBC) count; sputum culture positive for infecting organism; tachypnea; dyspnea; productive cough; tachycardia	Promote good hygiene; assist with hygiene as needed; administer prescribed antibiotics, antipyretics; provide cooling measures; administer prescribed intravenous fluids; monitor vital signs and trend temperatures; encourage oral fluids; adhere to standard or universal precautions; provide isolation as appropriate; obtain cultures as ordered; provide lightweight clothing and bedding; assess and monitor breath sounds; obtain ordered sputum specimen for culture; monitor and trend WBC results; monitor chest x-ray results
Airway (Related to congestion; sputum production)	Ineffective cough; purulent sputum; dyspnea; tachypnea; documented infiltrates; decreased or diminished breath sounds	Assess respiratory characteristics (rate, rhythm, depth, accessory muscle use); assess effectiveness of cough and amount of productivity; monitor sputum characteristics (color, viscosity); assess hydration status, encourage increased fluid intake; auscultate lungs for adventitious breath sounds (crackles); use pulse oximetry; administer prescribed oxygen; suction as needed; humidify oxygen as appropriate; encourage use of incentive spirometer; facilitate chest physiotherapy and nebulized treatments with mucolytic and bronchodilator medications; facilitate ordered bronchoscopy or thoracentesis
Gas exchange (Related to congestion [fluid in alveoli or mucous in airways]; mucous secretions; ventilation and perfusion mismatch; lung consolidation)	Decreased activity tolerance; increased shortness of breath with activity; weakness; orthopnea; cyanosis (pale, dusky); cough; increased heart rate; increased respiratory rate; use of respiratory accessory muscles; tachypnea; tachycardia; hypotension; restlessness; irritability; confusion; lethargy; disorientation; hypercapnia	Auscultate and trend breath sounds; use pulse oximetry to monitor oxygenation; administer oxygen as ordered; collaborate with physician to consider intubation and/or mechanical ventilation; place the head of the bed in high Fowler’s position; administer diuretics, vasodilators as ordered; assess for hypoxia (nailbeds, mucous membranes); monitor and trend blood pressure and heart rate; monitor for altered level of consciousness
Infection (Related to sexual exposure to C. trachomatis)	Purulent penile or vaginal drainage; dysuria; lower abdominal pain in women (pelvic inflammatory disease); testicular pain and swelling (epididymitis); pain, bleeding, and discharge from the rectum (proctitis); sometimes there are no symptoms	Provide written information about sexually transmitted diseases; complete a thorough history and physical assessment; administer prescribed antibiotics; teach patient to refrain from sexual activity until course of antibiotics is completed; explain that it may be necessary to have repeat testing 3 mo after initial treatment to assess for re-infection from sexual partner

Pretest

Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
Patient Teaching: Inform the patient this test can assist in diagnosing chlamydial infection.
Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
Obtain a history of the patient’s immune and reproductive systems, as well as results of previously performed laboratory tests and diagnostic and surgical procedures.
Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
Inform the patient that several tests may be necessary to confirm diagnosis. Any individual positive result should be repeated in 7 to 10 days to monitor a change in titer.
Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

Potential complications:
Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
Promptly transport the specimen to the laboratory for processing and analysis.

Post-Test

Inform that patient that a report of the results will be made available to the requesting health-care provider (HCP), who will discuss the results with the patient.
Recognize anxiety related to test results, and be supportive. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Emphasize the need to return to have a convalescent blood sample taken in 7 to 14 days. Educate the patient regarding access to counseling services.
Social and Cultural Considerations: Counsel the patient, as appropriate, as to the risk of sexual transmission and educate the patient regarding proper prophylaxis. Reinforce the importance of strict adherence to the treatment regimen.
Social and Cultural Considerations: Inform the patient with positive C. trachomatis that findings must be reported to a local health department official, who will question the patient regarding his or her sexual partners.
Social and Cultural Considerations: Offer support, as appropriate, to patients who may be the victim of rape or sexual assault. Educate the patient regarding access to counseling services. Provide a nonjudgmental, nonthreatening atmosphere for a discussion during which you explain the risks of sexually transmitted diseases. It is also important to discuss emotions the patient may experience (guilt, depression, anger) as a victim of rape or sexual assault.
Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
Patient Education
- Provide emotional support if the patient is pregnant and if results are positive.
- Inform the patient that chlamydial infection during pregnancy places the newborn at risk for pneumonia and conjunctivitis.
- Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP.
- Answer any questions or address any concerns voiced by the patient or family.
Expected Patient Outcomes
- Knowledge
- States understanding of the importance of increasing fluid intake to thin and mobilize secretions
- States understanding of completing course of antibiotics for chlamydial infection prior to engaging in sexual activity.
- Skills
- Demonstrates proficiency with cough and deep breathing
- Demonstrates proficient use of incentive spirometer
- Attitude
- Complies with the request to complete retesting for chlamydial infection in 3 mo.

Related Monographs

Related tests include culture bacterial (anal, genital), culture viral, Gram stain, Pap smear, and syphilis serology.
Refer to the Immune and Reproductive systems tables at the end of the book for related tests by body system.

Chlamydia Group Antibody, IgG and IgM