CONTEXT: Streptococcus pneumoniae (S. pneumoniae) infections are an important cause of mortality in young children. There are a number of problems associated with establishing the microbial etiology by conventional methods, thus highlighting the need for a rapid, improved and accurate test method. A rapid immunochromatographic assay has been developed for detecting a pneumococcal cell wall antigen common to all 92 serotypes. AIM: The aim of the study was to ascertain whether the Binax NOW test when performed on Cerebrospinal fluid (CSF) and pleural fluid can give any additional information vis a vis the culture and other methods of identification of S. pneumoniae. MATERIAL & METHODS: CSF and pleural fluid samples were collected from suspected cases of both meningitis and/or pneumonia with or without synpneumonic effusions in the age group of 28 days to 60 months. The samples were subjected to Gram's stain, culture and sensitivity, CRP, cell count, cell type, protein and sugar tests. In addition, the immunochromatographic test (ICT) (Binax NOW, Scarborough, ME) was performed on all samples to detect S. pneumoniae polysaccharide antigen. Polymerase chain reaction (PCR) was done in patients who had a positive ICT in the pleural fluid. RESULTS: A total of 104 children were recruited, of whom 90 were cases of suspected meningitis and 14 of pneumonia with synpneumonic effusions. The ICT result was positive in 19 patients, in 10 of 90 CSF and 9 of 14 pleural fluid samples. Culture for S. pneumoniae was positive in 6 cases (9 specimens). When ICT was compared to culture, the sensitivity of ICT was 100% (6/6) and the specificity was 85.97 (85/95). Streptococcus mitis (one), Staphylococcus epidermidis (one), Pseudomonas (one) isolated in culture gave false positive ICT results. Previous antibiotic exposure did not seem to alter the sensitivity of the test. CONCLUSION: To the best of our knowledge this is the first Indian study on Binax NOW test on CSF and pleural fluid. The ICT test performed on CSF and pleural fluid samples not only augments the standard diagnostic methods of blood and fluid cultures, but is useful even in patients with prior antibiotic therapy.
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