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Journal of Clinical Microbiology, December 1999, p. 4059-4064, Vol. 37, No. 12
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.
Detection by PCR of Neospora caninum in
Fetal Tissues from Spontaneous Bovine Abortions
Timothy V.
Baszler,1,2,*
Lawrence
J. C.
Gay,1
Maureen T.
Long,1,
and
Bruce A.
Mathison1
Department of Veterinary Microbiology and
Pathology1 and Washington Animal Disease
Diagnostic Laboratory,2 Washington State
University, Pullman, Washington
Received 16 April 1999/Returned for modification 19 July
1999/Accepted 15 September 1999
 |
ABSTRACT |
The routine diagnosis of Neospora caninum abortion is
based upon histopathologic changes in fetal tissues and identification of tissue parasites by immunohistochemistry. Confirmation of N. caninum infection by immunohistochemistry has low sensitivity. In
the present study, we examined the utility of PCR in detecting N. caninum infection in fetal tissues from spontaneous bovine abortion. DNA was obtained from fresh and formalin-fixed tissues from
61 bovine fetuses submitted for abortion diagnosis. Histopathology and
immunohistochemistry determined the true status of N. caninum infection in each fetus. In formalin-fixed
paraffin-embedded tissues, PCR detected N. caninum DNA in
13 of 13 true-positive fetuses (100%) and in 1 of 16 true-negative
fetuses (6%). In fresh or frozen tissues, PCR detected N. caninum DNA in 10 of 13 true-positive fetuses (77%) and 0 of 11 true-negative fetuses (0%). PCR also detected N. caninum
DNA in 6 of 8 fetuses that had typical lesions of N. caninum but were immunohistochemistry negative, indicating a
higher sensitivity of PCR in comparison to that of
immunohistochemistry. N. caninum DNA was amplified most
consistently from brain tissue. PCR detection of N. caninum
DNA in formalin-fixed, paraffin-embedded tissues was superior to that
in fresh tissues, presumably because of the increased accuracy of
sample selection inherent in histologic specimens.
 |
INTRODUCTION |
Bovine neosporosis, caused by the
apicomplexan protozoan parasite Neospora caninum, was
initially recognized in 1989 (35) and is now reported as a
leading infectious cause of reproductive failure in dairy cattle in
countries worldwide (2, 3, 14, 29, 36, 40). The principle
method of diagnosing Neospora caninum infection in aborted
fetuses is by histopathology (HP) of fetal tissues, followed by
specific identification of parasites within tissue lesions by
immunohistochemistry (IHC) (5, 13, 24). Typical fetal
lesions, which are not pathognomonic, include multifocal nonsuppurative
necrotizing encephalitis and nonsuppurative myocarditis with or without
focal necrosis in the liver (8, 39). IHC is relatively
insensitive as a confirmatory test for neosporosis because parasite
numbers in infected tissue can be very low, possibly leading to false
negatives (12, 14, 18). Fetal serology has been used to
confirm N. caninum abortion in individual fetuses, but the
assay is not highly sensitive, as demonstrated by two separate studies
where N. caninum-specific antibodies were present in only 50 to 65% of confirmed N. caninum-infected fetuses (6,
38). Maternal serology also is not consistently useful to confirm
N. caninum abortion in individual cows (28, 31,
33). Thus, there is a practical need for a fast and reliable method to confirm N. caninum infection in tissues from
aborted fetuses.
A sensitive and specific PCR detection assay for N. caninum
DNA would be useful to augment the diagnosis of N. caninum
abortion where pathologic changes in fetal tissues are consistent with neosporosis but cannot be consistently confirmed by IHC or serology. Although multiple PCR methods have been described for detection of
N. caninum DNA in bovine tissues (16, 18, 19, 21, 23, 32, 41), N. caninum PCR has been tested infrequently
for the routine diagnosis of naturally occurring N. caninum
abortion. Gottstein et al. (18) used pNC-5
Neospora PCR to define the N. caninum infection
status of 83 aborted bovine fetuses and identified a poor correlation
between N. caninum PCR-positive status and the presence of
N. caninum-compatible histologic lesions (nonsuppurative encephalitis and myocarditis) or N. caninum-positive
serology (18), suggesting that the true status of the
examined fetuses was not clearly identified. Ellis et al.
(15) reported only 16 of 40 positive cases identified by
ITS1 Neospora PCR in fetuses with brain and heart lesions
compatible with N. caninum abortion (15),
indicating a poor sensitivity of ITS1 PCR for clinical material. Thus,
there is a need for further studies using defined N. caninum-positive and N. caninum-negative fetal
populations to investigate the utility of PCR for the routine diagnosis
of naturally occurring N. caninum abortion in cattle.
In the present study, our laboratory extended the PCR methodology for
detection of the pNC-5 gene of N. caninum (41).
PCR and seminested-PCR procedures were optimized by using primers pairs
Np4-Np7 and Np6-Np7, and testing was done on groups of fetuses whose
N. caninum infection status was defined by HP and IHC. PCR assays were developed as a multiplex procedure and included the use of
primer pairs to the bovine prolactin (PRL) gene (27, 34) to
exclude false-negative results due to poor-quality DNA or unknown PCR
inhibitors in the clinical samples. The purposes of the study were (i)
to determine the utility of PCR for the identification of N. caninum infection in defined N. caninum-aborted bovine
fetuses; (ii) to determine the optimal fetal tissue to be analyzed by
PCR; (iii) to determine whether detection of DNA by N. caninum PCR was more sensitive than detection of tachyzoites by
IHC; (iv) to compare the utility of PCR assay of formalin-fixed, paraffin-embedded tissues with that of PCR assay of fresh tissues; and
(v) to determine whether detection of N. caninum infection in clinical fetal tissues requires nested PCR procedures.
 |
MATERIALS AND METHODS |
Clinical samples.
Whole cadavers or tissues from 61 naturally aborted bovine fetuses were submitted to the Washington
Animal Disease Diagnostic Laboratory for routine abortion diagnosis.
The fetuses originated from commercial dairy and beef herds in the
Pacific Northwest region of the United States (Washington, Idaho, and
Oregon). Abortion diagnosis examinations were part of an abortion
diagnostic kit that included examination of fetal tissues by
histopathology, bacterial culture, virus isolation, and examination of
maternal serum for antibodies to abortofacient pathogens (N. caninum, infectious bovine rhinotracheitis herpesvirus [IBR],
bovine virus diarrhea virus [BVDV], leptospires [Leptospira
icterohemorrhagica, L. hardjo, L. canicola,
L. pamona, L. bratislava, and L. grippotyphosa], and Brucella abortus). N. caninum antibodies were detected in the dams by competitive
enzyme-linked immunosorbent assay (ELISA; VMRD Inc., Pullman, Wash.)
modified from a previously published procedure (10). A total
of 162 fetal tissue samples were examined by N. caninum PCR;
these included samples from brain, heart, kidney, liver, lung, spleen,
and placenta. Not all tissues were available from all fetuses.
Experimental design.
Fetuses were grouped as outlined in
Table 1 by tissue treatment
(formalin-fixed, paraffin-embedded versus fresh or frozen) and N. caninum infection status (true status) as determined by HP and
IHC. Fetuses classified as N. caninum true positive (group 1) had histopathologic changes consistent with N. caninum
infection and tachyzoites within affected tissues detectable by IHC
(HP+ IHC+). For the purposes of the present
study, histopathologic changes compatible with N. caninum
abortion had to be present, at a minimum, in the brain and heart
(4, 39). The targeted lesions consisted of moderate or
severe multifocal necrosis and gliosis in the brain associated with
nonsuppurative encephalitis and moderate or severe nonsuppurative
myocarditis. Fetuses classified as N. caninum true negative
(group 2) had no lesions compatible with N. caninum
infection and no detectable N. caninum tachyzoites by IHC
(HP
IHC
) and served as the uninfected
negative control group. The N. caninum-negative group
contained fetuses diagnosed as resulting from idiopathic abortion,
sporadic bacterial abortion, BVDV abortion, and IBR virus abortion. A
third group of fetuses had histopathologic changes of N. caninum abortion but no tachyzoites were found by IHC
(HP+ IHC
); these fetuses were used to compare
the abilities of PCR and IHC to detect N. caninum infection.
The following comparisons were analyzed by chi-square analysis using
2 × 2 contingency tables: (i) PCR detection of
N. caninum infection in formalin-fixed tissues versus fresh tissues
(Table
1, group 1 versus group 4), and (ii) PCR detection of
N. caninum infection versus IHC detection of
N. caninum
infection (Table
1, group 1 versus group 3). The specificity and
sensitivity of
detection of
N. caninum infection by PCR were
determined for formalin-fixed
and fresh tissues by using the
HP
+ IHC
+ groups as true positives and the
HP

IHC

groups as true negatives.
Sensitivity was defined in the HP
+ IHC
+ groups
(Table
1, groups 1 and 4) by the following formula: sensitivity
= (PCR-positive fetuses/true-positive fetuses) × 100. Specificity
was defined in the HP

IHC

groups (Table
1,
groups 2 and 5) by the following formula: specificity
= PCR-negative fetuses/true-negative fetuses) × 100. Agreement
(concordance) between PCR detection of
N. caninum DNA and
true
status (as determined by HP and IHC) was defined by the following
formula: agreement = [(PCR-positive fetuses + PCR-negative
fetuses)/(true-positive
fetuses + true-negative fetuses)] ×
100.
Histopathology and immunohistochemistry.
Fetal tissues were
fixed in 10% neutral buffered formalin, paraffin embedded, and stained
with hematoxylin and eosin for routine histologic examination. A second
set of paraffin sections were mounted on positive-charged glass slides
(Probe-On Plus; Fisher Scientific) and processed for IHC as previously
described (24, 26) with avidin-biotin-complex (ABC)
immunoperoxidase methods (Vector Elite ABC-peroxidase) with an
automated capillary action immunostainer (Vantana Inc.). Sections were
dehydrated, enzymatically treated with 0.1% protease XIV (Sigma
Chemical Co., St. Louis, Mo.) for antigen retrieval, and incubated with
5% normal horse serum (Vector Laboratories, Burlingame, Calif.) to
block nonspecific immunoglobulin binding. The primary antibody was
anti-N. caninum hyperimmune goat serum (VMRD Inc.) diluted
1:2,000. Immunostaining was visualized with amino-ethyl-carbazol
substrate (Dako Inc.), and sections were counterstained with Mayer's
hematoxylin (Sigma Diagnostics, St. Louis, Mo.) and examined
microscopically. Positive control tissue consisted of formalin-fixed
brain tissue from BALB/c mice experimentally inoculated with the NC-1
strain of N. caninum (25). Negative controls
consisted of (one) replacement of the primary antibody with a similar
dilution of normal goat serum on all examined tissues. The specificity
of the anti-N. caninum goat serum was confirmed in-house by
the absence of immunoreactivity on archived tissue sections containing
previously confirmed Toxoplasma gondii tachyzoites (cat with
systemic toxoplasmosis) or Sarcocystis cruzi tachyzoites
(bovine sarcocystosis abortion).
PCR.
PCR analysis was done by using primer pairs Np4-Np7 and
Np6-Np7 of the pNC-5 gene of N. caninum (41) in
standard or seminested PCR procedures. The Np4-Np7 primer pair is one
of several pairs previously shown to be specific for N. caninum when tested against Toxoplasma,
Sarcocystis, and Hammondia spp. (41).
Preliminary studies in our laboratory using spiked bovine blood or
spiked bovine brain showed that primer pair Np4-Np7, when used in a
standard procedure or when used before primer pairs Np6-Np7 in a
seminested procedure, provided optimal results in bovine tissues (data
not shown). The Np4-Np7 primer pair amplifies a DNA fragment of 275 bp,
and the Np6-Np7 primer pair amplifies a DNA fragment of 227 bp. To
exclude the possibility of false-negative PCR results due to
poor-quality DNA or the presence of nonspecific PCR inhibitors in the
clinical tissue samples, all samples negative when N. caninum primer pairs alone were used were retested with a
multiplex PCR, using N. caninum primers and PCR primers for
the PRL gene, a constitutive gene expressed in bovine cells (27,
34). The PRL HL033-HL035 primer pair amplifies a 156-bp DNA
fragment. Any fetal tissue samples that were PCR negative for both PRL
and N. caninum were excluded from the study because of the
poor quality of DNA in the clinical sample.
PCR sensitivity.
The methodological sensitivity of the
standard PCR procedure was determined from fresh bovine brain spiked
with purified cell culture-derived N. caninum tachyzoites
(NC-1 isolate). Parasites were grown in Vero cells and purified by
centrifugation in Percoll as described previously (10) and
then counted with a hemocytometer. Zero, 10, 20, 30, 40, 50, 500, and
5,000 purified tachyzoites were diluted in culture medium, mixed with
20 mg of homogenized brain tissue, and DNA extracted for PCR.
Sensitivity was expressed as organism equivalents as determined by
microgram of DNA in the PCR by the following formula: tachyzoite
equivalents = [(150 ng/total nanograms of DNA extracted in
sample) × 100] × number of tachyzoites spiked in sample.
DNA extraction from fresh and formalin-fixed, paraffin-embedded
tissue.
DNA was extracted from fresh or frozen and from
formalin-fixed, paraffin-embedded tissues by using proteinase K
digestion followed by ethanol precipitation without phenol-chloroform
extraction (11, 22). Twenty milligrams of tissue was used
for DNA extraction from fresh tissues. For formalin-fixed tissues, four
10-µm paraffin sections were cut with a standard microtome, placed in
a 1.5-ml microcentrifuge tube with a sterile forceps, and dewaxed with xylene and ethanol washes. The microtome blade was cleaned between blocks with a xylene substitute (Histoclear) and 70% ethanol to prevent carryover. An empty microcentrifuge tube (lacking paraffin sections similarly processed) was included every 10 tubes as a paraffin
negative control for contamination during sectioning. DNA was
precipitated from digested tissue by using an equal volume of 4 M
ammonium acetate followed by 2 volumes of isopropanol. The
concentration of DNA was determined by spectrophotometric analysis at
A260/280. Only DNA with
A260/280 ratios of >1.0 were kept for PCR
analysis. Tissue DNA was stored at
80°C.
The PCR mixture of 50 µl contained 150 ng of target DNA, 2 mM
MgCl
2, 10× reaction buffer (50 mM KCl, 10 mM Tris-HCl [pH
8.3],
0.1% Triton X-100), 1 mg of gelatin per ml, 10 pmol of each PCR
primer, 200 µM each dNTP, and 2 U of
Taq DNA polymerase.
PCRs
using Np4 (5'CCTCCCAATGCGAACGAAA3') and Np7
(5'GGGTGAACCGAGGGAGTTG3')
were performed in a thermocycler
(GeneAmp 2400; Perkin-Elmer)
for 35 cycles of denaturation at 95°C
for 30 s, annealing at 57°C
for 30 s, and extension at
72°C for 60 s. For multiplex PCR, similar
concentrations of both
Np4-Np7 and PRL primers HL033 (5'CGAGTCCTTATGAGCTTGATTCTT3')
and HL035 (5'GCCTTCCAGAAGTCGTTTGTTTTC3') were
simultaneously added
to the PCR mixture described above. For seminested
PCR, second-round
primers Np6 (5'CAGTCAACCTACGTCTTCT3') and
Np7 (5'GGGTGAACCGAGGGAGTTG3')
used 2 µl of amplicon
solution from first-round Np4-Np7 PCR amplification
as target DNA with
the same PCR mixture with 35 cycles of denaturation
at 95°C for
30 s, annealing at 56°C for 30 s, and extension at
72°C
for 60 s. Amplicons were resolved on a 1.8% agarose gel stained
with ethidium bromide and photographed under UV light. Positive
controls (purified
N. caninum tachyzoite DNA) and negative
controls
(DNA from normal bovine brain, paraffin control, and no DNA
(double-distilled
water) were included in each PCR run. PCR products
were sequenced
and compared to known published sequences to confirm
that the
correct DNA targets were being
amplified.
 |
RESULTS |
Methodological sensitivity of Neospora PCR in spiked
bovine brain.
To determine the detection limit of the PCR assay in
bovine tissues, PCR was performed on normal fresh bovine brain tissue spiked with N. caninum tachyzoites. Tachyzoite equivalents
were calculated by the amount of target DNA in the PCR; generally, 150 ng of target DNA represented 3 to 6% of total DNA in the sample. Figure 1 shows a weak 275-bp band at 1 to
2 tachyzoite equivalents and a strong 275-bp band at
3 tachyzoite
equivalents. The results indicated an adequate detection limit, in the
range of 20 to 40 tachyzoites in 20 mg of bovine brain tissue, to
pursue PCR detection of N. caninum in clinical samples.

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FIG. 1.
Detection limit of N. caninum PCR in bovine
brain spiked with tachyzoites. Total DNA was isolated from spiked
bovine brain, and parasite DNA was detected by using the Np4-Np7 primer
pair of the pNC-5 gene of N. caninum. PCR products were
separated on agarose gel and stained with ethidium bromide. Lane 1, molecular mass ladder (100 kb); lanes 2 to 9, 20 mg of uninfected
bovine brain spiked with 5,000, 500, 50, 40, 30, 20, 10, and 0 N. caninum tachyzoites, respectively (numbers at the tops of the
lanes indicate N. caninum tachyzoite equivalents based upon
micrograms of DNA loaded in the PCR as described in Materials and
Methods); lane 10, positive control (N. caninum DNA from
Vero cell cultures); lane 11, negative control (double-distilled
water). Left arrow, specific 275-kb Np4-Np7 PCR product detected in
lanes 2 to 7 and 10. The bottom bands are nonspecific unused PCR
reagents and primer dimers.
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|
Sensitivity and specificity of Neospora PCR in clinical
samples.
The sensitivity and specificity were determined for PCR
of fresh and paraffin-embedded tissues by using defined
Neospora-positive and Neospora-negative fetuses
(Table 1, groups 1, 2, 4, and 5). All fetal samples were initially
tested with the Np4-Np7 primer pair only (Fig.
2). All PCR-negative samples were
subsequently tested by using seminested PCR with Np4-Np7 followed by
Np6-Np7 to increase the methodological sensitivity of the PCR assay.
Finally, all samples negative by seminested PCR were tested with
multiplex PCR using Neospora primer pair Np4-Np7 and primer
pair HL033-HL035 to bovine PRL to identify false negatives due to
poor-quality DNA or the presence of PCR inhibitors in the fetal tissue
samples (Fig. 3). An N. caninum-positive PCR amplicon from any fetal tissue sample
classified that particular fetus as PCR positive. The PCR results from
the clinical samples are summarized in Table
2. Sensitivities of PCR were 100% for
formalin-fixed, paraffin-embedded brain tissue (13 of 13 true-positive
fetuses were PCR positive) and 77% for fresh brain (10 of 13 true-positive fetuses were PCR positive). Specificities of PCR were
94% for formalin-fixed paraffin-embedded brain tissue (1 to 16 true-negative fetuses were PCR positive) and 100% for fresh brain (0 of 13 true-negative fetuses were PCR positive). Agreement (concordance)
rates between N. caninum PCR and true status were 97% for
formalin-fixed, paraffin-embedded tissue and 88% for fresh tissue.
Chi-square analysis comparing detection of N. caninum DNA in
formalin-fixed tissue with that in fresh tissue samples revealed no
significant difference (P > 0.05).

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FIG. 2.
PCR detection of N. caninum in formalin-fixed
paraffin-embedded tissues from aborted bovine fetuses. DNA was isolated
as described in Materials and Methods, and parasite DNA was detected by
using the Np4-Np7 primer pair of the pNC-5 gene of N. caninum. A representative illustration of PCR products separated
on agarose gels and stained with ethidium bromide is shown. Lane 1, molecular mass ladder (100 kb); lane 2, positive control (N. caninum DNA); lanes 3 to 5, kidney (positive for N. caninum detection), brain (positive), and liver (negative) tissue
from N. caninum-positive fetus 97-8417; lane 6, paraffin
negative control; lanes 7 to 11, kidney (negative), lung (negative),
liver (negative), heart (positive), and brain (positive) tissues from
N. caninum-positive fetus 97-4707; lane 12, paraffin
negative control; lane 13, brain tissue (negative) from N. caninum-negative fetus (IBR abortion) 96-713; lanes 14 and 15, brain (positive) and heart (negative) tissue from N. caninum-positive fetus 92-9309; lane 16, PCR-negative control
(double-distilled water). Left arrow, specific 275-kb Np4-Np7 PCR
product. Bottom bands are nonspecific unused PCR reagents and primer
dimers.
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FIG. 3.
Multiplex PCR of N. caninum DNA and PRL DNA
in formalin-fixed paraffin-embedded tissues from aborted bovine
fetuses. Parasite DNA was detected by using the Np4-Np7 primer pair of
the pNC-5 gene of N. caninum, and bovine PRL DNA was
detected by using primer pair HL033-HL035. A representative
illustration of PCR products separated on agarose gels and stained with
ethidium bromide is shown. Lane 1, molecular mass ladder (100 kb);
lanes 2 to 4, liver, heart, and brain tissue from N. caninum-negative fetus 96-10792 with detection of PRL DNA only;
lanes 5 and 6, brain and kidney tissue from fetus 96-6445 with no
detectable N. caninum or PRL DNA; lanes 7 and 8, brain and
lung tissue from fetus 96-6445 with no detectable N. caninum
or PRL DNA; lane 9, brain tissue from N. caninum-positive
fetus 94-4569 with detectable N. caninum and PRL DNA; lanes
10 to 14, N. caninum-infected Vero cell cultures with
detectable N. caninum DNA only (bovine PRL-negative
control); lanes 15 and 16, PCR-negative control (double-distilled
water). Left markers indicate a specific 275-kb Np4-Np7 PCR product
detected in lanes 9 to 14 and a specific 156-kb HL033-HL035 PCR product
detected in lanes 2 to 4 and 9.
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|
Tissue distribution of N. caninum DNA detected by PCR
in N. caninum-infected fetuses.
The distribution and
frequency of N. caninum infection in tissue were determined
by Np4-Np7 PCR by using both formalin-fixed, paraffin-embedded tissues
and fresh tissues (Table 3). With
formalin-fixed, paraffin-embedded tissues, brain tissue was optimal for
standard PCR detection of N. caninum, with 100% of defined
positive cases being detected. The detection rate of standard PCR in
fixed brain tissue was far superior to that in all other fixed tissues
examined, with the detection rate for other tissues ranging from 17 to
50%. With fresh tissues, kidney and brain were optimal for standard PCR detection of N. caninum infection, with detection rates
of 100 and 88%, respectively. Detection rates were much lower in other
fresh tissues and ranged from 0 (spleen and placenta) to 60% in heart
tissue.
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TABLE 3.
Tissue distribution of parasite DNA and comparison of
nested and standard PCR methods for detection of N. caninum PCR
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|
Comparison of nested and standard PCRs in clinical samples.
All tissues from defined true-positive fetuses (Table 1, groups 1 and
4) were also tested by seminested PCR to determine whether nested PCR
would increase the sensitivity of detecting N. caninum in an
individual tissue over that of standard PCR (Table 3). Seminested PCR
was superior to standard PCR for all fetal tissues tested except for
formalin-fixed brain. Of both fresh and formalin-fixed tissues, five
had greater than 75% detection rates by seminested PCR. However, the
ability to identify an N. caninum-infected fetus was not
improved by the seminested PCR procedure, compared to standard PCR,
because standard PCR detected N. caninum DNA in at least one
tissue (formalin-fixed brain) in 100% of the true-positive cases. In
fresh tissues, detection of all true-positive fetuses by standard PCR
required examination of at least two fetal tissues, brain and kidney.
Thus, seminested PCR did not increase the sensitivity of detecting
N. caninum infection in aborted bovine fetuses.
Comparison of PCR and IHC to detect Neospora infection
in clinical samples.
Aborted fetuses from group 3 (Table 1) were
tested to determine whether PCR was more sensitive than IHC in
detecting N. caninum-infected fetuses. Brain tissue was
chosen for the comparative analysis because the most consistent and
diagnostic lesions of N. caninum infection occur in brain
(4), and tachyzoites are most commonly associated with brain
lesions in infected fetuses (5, 39). All PCR analyses were
done on formalin-fixed, paraffin-embedded tissues. Both Np4-Np7 PCR and
seminested PCR using Np4-Np7 followed by Np6-Np7 detected N. caninum DNA in six of eight (75%) fetuses that were IHC negative.
Chi-square analysis comparing detection rates of N. caninum
in formalin-fixed tissue samples by PCR and IHC revealed a significant
difference (P < 0.01).
 |
DISCUSSION |
The goal of the present study was to apply PCR technology to the
routine diagnosis of N. caninum-induced abortion in cattle. The exquisite sensitivity of PCR to detect small numbers of parasites in tissue together with the ability of HP to select appropriate tissue
sections for PCR analysis (based upon the presence of tissue lesions)
provide an ideal combination to reliably identify parasites and link
them directly to areas of tissue damage. We determined the sensitivity
and specificity of pNC-5 PCR by using fetuses defined as true N. caninum positive or true N. caninum negative. The
"gold standard" criteria used to determine true N. caninum infection status were HP and IHC, a rationale supported by
abundant literature showing that N. caninum infection in
aborted bovine fetuses most consistently causes encephalitis and
myocarditis (9, 14, 39). Chi-square analysis comparing
fixed- and fresh-tissue PCRs revealed no statistically significant
difference in detecting infection in 26 N. caninum-positive
fetuses. However, when the 26 N. caninum-positive fetuses
and 27 N. caninum-negative fetuses were analyzed, the
sensitivity of fixed-tissue PCR (100%) and agreement with true status
(97%) were superior to the sensitivity of the fresh-tissue PCR (77%)
and agreement with true status (88%). The increased sensitivity of
fixed-tissue PCR was attributed to the increased accuracy of sample
selection inherent in histologic specimens. Fixed-tissue sections
contained known tissue lesions, while the lesion status of fresh-tissue
specimens was unknown. In summary, both fixed-tissue and fresh-tissue
pNC-5 PCR using the Np4-Np7 primer pair provided adequate methods to
confirm N. caninum infection in aborted fetuses.
Fixed-tissue PCR detected N. caninum infection in one
true-negative fetus. It is well known that congenital infection is the primary mode of parasite transmission and that most congenitally infected calves are born clinically normal (30, 37). It is highly likely some fetuses that aborted for other causes or were diagnosed as resulting from idiopathic abortions in the present study
may have had a mild, subclinical N. caninum infection that was below the detection limits of the gold standard methods (HP and
IHC). The one PCR-positive fetus detected in the fixed-tissue true-negative group may be a good example of the new test (PCR) being
more sensitive than the gold standard and possibly skewing the
specificity data.
The pNC-5 PCR analyses showed that brain was the most reliable tissue
overall for PCR analysis and that a nested PCR procedure (to increase
sensitivity and specificity) was not necessary to detect N. caninum-infected fetuses. Reliable detection of N. caninum DNA in brain tissue by PCR is not surprising and is
consistent with previous studies showing tissue parasites detected most
frequently in brain by IHC or PCR (7, 14, 20, 39).
Demonstrating the reliability of a standard PCR procedure for detecting
N. caninum infection is important because one of the main
disadvantages of PCR for routine diagnosis of infectious diseases is
amplicon contamination, which may lead to false-positive tests. The
chances of amplicon contamination increase significantly with a nested
procedure, in which there is increased handling of amplicons from the
first-round PCR and up to 1,000 times increased efficiency at
generating second-round amplicons (22).
Another goal of the present study was to determine whether pNC-5 PCR
was more sensitive than IHC in detecting N. caninum
infection in fetal tissues. The finding of fetuses with N. caninum-compatible tissue lesions but no demonstrable parasites by
immunohistochemistry (HP+ IHC
) is a common
occurrence in routine diagnostic examinations of aborted bovine
fetuses. The classification of these fetuses is unclear because
Neospora-like lesions can also occur with other infectious
agents (1, 17). This finding may ironically overrepresent N. caninum infections in fetuses because the cause of the
abortion is not definitively confirmed. In the present study, PCR
analysis of formalin-fixed tissues from HP+
IHC
fetuses showed that both standard and seminested
pNC-5 PCR detected N. caninum DNA at similar rates in six of
eight fetuses that were IHC negative, a significant difference by
chi-square analysis. This data supports other studies suggesting that
the routine practice of screening aborted fetal tissues by HP and
confirming infection by using IHC is not a particularly sensitive or
consistent way to identify true N. caninum infections
(14, 18). Diagnosis of N. caninum abortion would
be more accurate if a strategy of screening fetal tissues with
histopathology followed by confirmation of N. caninum
infection with standard pNC-5 PCR on serial sections from the same
paraffin block was used.
In conclusion, the present study demonstrates the utility of PCR-based
assay to identify N. caninum infection in spontaneously aborted bovine fetuses. PCR detection of N. caninum DNA
worked well on formalin-fixed paraffin-embedded tissue, which increases the practical application of a PCR-based assay. When interpreted in
conjunction with significant histopathologic changes in aborted fetal
tissues, PCR should provide a valuable confirmatory tool to diagnose
N. caninum abortion in cattle and makes possible
retrospective analyses of archived clinical samples. In addition, the
ability to amplify parasite-specific DNA from formalin-fixed or fresh clinical samples provides a new method to obtain N. caninum
genetic material for analysis of strain genotype or variation of
specific parasite genes.
 |
ACKNOWLEDGMENTS |
We acknowledge the technical assistance of the Washington Animal
Disease Diagnostic Laboratory, in particular, Victor Tobias and Nancy
Weber of the histology laboratory and Pam Dilbeck and Ruth Brown of the
IHC laboratory.
 |
FOOTNOTES |
*
Corresponding author. Mailing address: Department of
Veterinary Microbiology and Pathology, Bustad Hall, Washington State University, Pullman, WA 99164-7040. Phone: (509) 335-6047. Fax: (509)
335-8529. E-mail: baszlert{at}vetmed.wsu.edu.
Present address: Department of Large Animal Clinical Sciences,
College of Veterinary Medicine, University of Florida, Gainesville, FL
32610-0136.
 |
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Journal of Clinical Microbiology, December 1999, p. 4059-4064, Vol. 37, No. 12
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.
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