Comparison of laboratory tests for the detection of Bordetella pertussis

Comparison of laboratory tests for the detection of Bordetella pertussis

Laboratory method	Reported sensitivity^*	Reported specificity^*	Comments
Culture of nasopharyngeal secretions	20 to 80% (decreases with increasing duration of cough)	100%	Traditional reference standard for diagnosis. Sensitivity depends on duration of symptoms and decreases after two weeks of illness; prior vaccination or antibiotic exposure also decrease sensitivity. Permits antibiotic susceptibility testing and strain serotyping (helpful in outbreak setting). Results available in three to seven days. Not available in all laboratories. In an outbreak setting, confirmation is recommended for at least one case of suspected pertussis.
Polymerase chain reaction of nasopharyngeal secretions^¶	61 to 94%	88 to 98%	Rapidly available results. More sensitive than culture, but sensitivity decreases after three weeks of illness. No standard methodology. Subject to contamination, especially during outbreaks. May also be positive in Bordetella holmesii and Bordetella bronchiseptica. May detect nonviable Bordetella pertussis organisms.
Serology (ELISA) blood	60 to 95%	Δ	A CDC/FDA-developed assay has been useful in outbreak settings; the accuracy of commercially available assays is not known. In general, serology is most useful for diagnosis two to eight weeks after cough onset. A single high antibody titer above a designated threshold may be sufficient and obviate the need for acute/convalescent titers; this cutoff is often laboratory specific.

CDC: Centers for Disease Control and Prevention; ELISA: enzyme-linked immunosorbent assay; FDA: US Food and Drug Administration.

* Reported sensitivities and specificities taken from clinical or epidemiologic studies or vaccine trials.

¶ Compared with clinical case definitions+serology in most studies.

Δ Not readily available from epidemiologic studies. An investigation in German adults found a specificity of 84% using a clinician's clinical diagnosis as a gold standard (Schmitt-Grohé S, Cherry JD, Heininger U, et al. Pertussis in German adults. Clin Infect Dis 1995; 21:860).

Data from:

Centers for Disease Control and Prevention. Pertussis (Whooping Cough). Specimen Collection and Diagnostic Testing. Available at: https://www.cdc.gov/pertussis/clinical/diagnostic-testing/specimen-collection-diagnosis.html (Accessed on August 28, 2023).
Centers for Disease Control and Prevention. Best practices for health care professionals on the use of polymerase chain reaction (PCR) for diagnosing pertussis. http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-pcr-bestpractices.html (Accessed on June 28, 2018).
Cherry JD, Tan T, Wirsing von König CH, et al. Clinical definitions of pertussis: Summary of a Global Pertussis Initiative roundtable meeting, February 2011. Clin Infect Dis 2012; 54:1756.
Güriş D, Strebel PM, Bardenheier B, et al. Changing epidemiology of pertussis in the United States: Increasing reported incidence among adolescents and adults, 1990-1996. Clin Infect Dis 1999; 28:1230.
Heininger U, Schmidt-Schläpfer G, Cherry JD, Stehr K. Clinical validation of a polymerase chain reaction assay for the diagnosis of pertussis by comparison with serology, culture, and symptoms during a large pertussis vaccine efficacy trial. Pediatrics 2000; 105:E31.
Kerr JR, Matthews RC. Bordetella pertussis infection: Pathogenesis, diagnosis, management, and the role of protective immunity. Eur J Clin Micribiol Infect Dis 2000; 19:77.
Kösters K, Riffelmann M, Dohrn B, von König CH. Comparison of five commercial enzyme-linked immunosorbent assays for detection of antibodies to Bordetella pertussis. Clin Diagn Lab Immunol 2000;7:422.
Lind-Brandberg L, Welinder-Olsson C, Lagergård T, Taranger J, Trollfors B, Zackrisson G. Evaluation of PCR for diagnosis of Bordetella pertussis and Bordetella parapertussis infections. J Clin Microbiol 1998; 36:679.
Loeffelholz MJ, Thompson CJ, Long KS, Gilchrist MJ. Comparison of PCR, culture, and direct fluorescent-antibody testing for detection of Bordetella pertussis. J Clin Microbiol 1999; 37:2872.

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Comparison of laboratory tests for the detection of Bordetella pertussis