Diagnosis of Pneumococcal Pneumonia in Epidemiological Studies: Evaluation in Kenyan Adults of a Serotype‐Specific Urine Latex Agglutination Assay

Scott, John A.; Hannington, A.; Marsh, Kevin; Hall, Andrew J.

doi:10.1086/515198

Cited by 27 publications

(22 citation statements)

References 38 publications

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“…In contrast to our observations, only 39% of patients with strongly positive Binax NOW Streptococcus pneumoniae urinary antigen tests were positive in that study. Interestingly, the study of Scott et al (18) reported no significant difference in the positivity rate among blood culture-positive and blood culture-negative patients, whereas in this investigation, the positivity rate was considerably lower in pneumonia patients with no confirmatory blood culture. The significance of this disparity is unclear but may indicate that the proportion of pneumonias of pneumococcal etiology may genuinely be low in this sample.…”

Section: Discussioncontrasting

confidence: 77%

“…Capeding and colleagues used seven tube latex agglutination assays to detect 10 capsular polysaccharide antigens in urine from 26 children with lower respiratory tract infection and reported a positivity rate of 42% (3), although independent confirmation of the microbiological status of the patients was not available for many of subjects. Scott and coworkers also used tube latex agglutination to assay 10 capsular serotypes in the urine of patients with pneumonia and, in 72 samples, obtained a sensitivity of 46% overall and 57% among patients from whom blood cultures or lung aspirates yielded pneumococci with a serotype in their assay panel (18). Strålin et al (23) used 22 latex-bound antibody preparations, covering the 23 serotypes in the current plain polysaccharide vaccine, in slide agglutination assays with patients' urine.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis of Invasive Pneumococcal Infection by Serotype-Specific Urinary Antigen Detection

et al. 2005

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Widespread use of conjugate pneumococcal polysaccharide-protein vaccines may alter the spectrum of pneumococci producing invasive disease. Novel sensitive diagnostic methods would be valuable for monitoring the epidemiology of pneumococcal disease within populations and vaccine recipients. Ideally, these methods should allow determination of the serotype of the infecting clone. Serotype-specific enzyme-linked immunosorbent assays (ELISA) for 13 capsular polysaccharides (types 1, 3, 4, 5, 6A, 6B, 7A, 9V, 14, 18C, 19A, 19F, and 23F) were developed. Experiments with pure capsular polysaccharide demonstrated that the assays were sensitive (0.01 to 1.0 ng/ml) and specific. These assays were used to detect capsular polysaccharide in urine from 263 adult patients with proven (blood culture-positive) invasive pneumococcal disease and pneumonia of unknown etiology and from patients with positive blood cultures yielding bacteria other than pneumococci (control group). Among 76 patients with invasive pneumococcal disease from whom blood culture isolates had been serotyped, 62 (82%) had infections with pneumococci of serotypes represented in the ELISA panel. Capsular antigen matching the serotype of the blood culture isolate was detected in the urine of 52 of these patients, giving a sensitivity of 83.9% for the target serotypes. The tests were significantly more sensitive for urine from patients with pneumococcal pneumonia (89.8%) than for urine from patients with nonpneumonic invasive infection (61.5%; P < 0.05). Data from the control group indicated a specificity of 98.8%. These assays should prove valuable in epidemiological investigation of invasive pneumococcal infection in adults, particularly if combined with a sensitive C-polysaccharide detection assay to screen for positive samples.

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Section: Discussioncontrasting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Diagnosis of Invasive Pneumococcal Infection by Serotype-Specific Urinary Antigen Detection

et al. 2005

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“…Serotype-specific antigen detection in urine has been attempted before, with excellent specificity (98-99%), but disappointing sensitivity (55-84%), when compared with S. pneumoniae isolates detected in sterile sites [19][20][21][22]. The sensitivity of the ICA test in the present study was 63%.…”

Section: Discussionmentioning

confidence: 59%

“…Although the presence of carriage with multiple serotypes has been described [23][24][25], infections caused by multiple serotypes have been reported only sporadically [20,21,26,27]. Recently, five out of 366 patients with pneumococcal CAP had pneumonia caused by two serotypes based on a multiplex immunoassay for 14 serotypes in urine samples [28].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of a serotype-specific antigen test in community-acquired pneumonia

et al. 2013

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Our aim was to evaluate the diagnostic accuracy and clinical utility of a serotype-specific urinary antigen detection multiplex assay for identification of 13 pneumococcal serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F) in urine of patients with community-acquired pneumonia.Adult patients with clinical suspicion of community-acquired pneumonia were included. In addition to standard diagnostic procedures, a urine sample was collected to perform the urinary antigen detection test. Demographic, clinical, radiological and microbiological data were collected.Among 1095 community-acquired pneumonia patients Streptococcus pneumoniae was identified as causative pathogen in 257 (23%), when using conventional diagnostic methods and in 357 (33%) when urinary antigen detection was added. Of the 49 bacteraemic episodes caused by one of the 13 serotypes covered by the urinary antigen detection, 48 were detected by the urinary antigen detection, indicating a sensitivity of 98%. Of the 77 community-acquired pneumonia episodes with a ''non-urinary antigen detection'' causative pathogen, none had a positive urinary antigen detection result, indicating a specificity of 100%.Addition of the urinary antigen detection test to conventional diagnostic methods increased the prevalence of S. pneumoniae community-acquired pneumonia by 39%. Using bacteraemic episodes as reference sensitivity and specificity of the urinary antigen detection was 98% and 100%, respectively. @ERSpublications Addition of urinary antigen detection test to conventional diagnostic methods increases prevalence of S. pneumoniae CAP http://ow.ly/nSA1l

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“…In contrast, the performance of other methods for detection of S. pneumoniae antigen in urine has been inconsistent, with sensitivities ranging from 0 to Ͼ80%, usually Ͻ50% (2, 3,6,7,14,16,18,20). The improved sensitivity of the NOW S. pneumoniae urinary antigen test may be due, in part, to the detection of the cell wall C polysaccharide common to all S. pneumoniae strains, rather than type-specific capsular polysaccharides.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a Rapid Immunochromatographic Test for Detection of Streptococcus pneumoniae Antigen in Urine Samples from Adults with Community-Acquired Pneumonia

et al. 2001

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Streptococcus pneumoniae is the most common cause of community-acquired pneumonia but is undoubtedly underdiagnosed. Isolation of S. pneumoniae from blood is specific but lacks sensitivity, while isolation of S. pneumoniae from sputum may represent colonization. We evaluated a new immunochromatographic test (NOW S. pneumoniae urinary antigen test; Binax, Portland, Maine) that is simple to perform and that can detect S. pneumoniae antigen in urine within 15 min. Urine samples from 420 adults with community-acquired pneumonia and 169 control patients who did not have pneumonia were tested. Urine from 315 (75%) of the pneumonia patients and all controls was tested both before and after 25-fold concentration, while the remaining 105 samples were only tested without concentration. S. pneumoniae urinary antigen tests were positive for 120 (29%) patients with pneumonia and for none of the controls. Of the urine samples tested with and without concentration, 96 were positive, of which 6 were positive only after concentration. S. pneumoniae antigen was detected in the urine from 16 of the 20 (80%) patients with blood cultures positive for S. pneumoniae and from 28 of the 54 (52%) patients with sputum cultures positive for S. pneumoniae. The absence of S. pneumoniae antigen in the urine from controls suggests that the specificity is high. Concentration of urine prior to testing resulted in a small increase in yield. The NOW S. pneumoniae urinary antigen test should be a useful adjunct to culture for determining the etiology of community-acquired pneumonia in adults.Streptococcus pneumoniae has consistently been shown to be the most common cause of community-acquired pneumonia (CAP) in both adults and children. S. pneumoniae accounts for about two-thirds of cases where an etiologic diagnosis is made (12) and is likely to be the leading cause of pneumonia of otherwise unknown etiology (19). Despite being the single most important pathogen causing CAP, S. pneumoniae is undoubtedly underdiagnosed due to limitations of conventional diagnostic tests. Isolation of S. pneumoniae from blood lacks sensitivity, isolation of S. pneumoniae from sputum may represent colonization, and lung aspirates are rarely performed. In an effort to improve the diagnostic yield for patients with suspected pneumonia, there has been a considerable interest in alternative techniques, such as PCR and antigen detection.Detection of S. pneumoniae antigens in the urine of patients with pneumonia was first described in 1917 (8). Over the intervening years the detection of S. pneumoniae antigens (usually capsular polysaccharides) in urine has been extensively studied using a variety of techniques, including counterimmunoelectrophoresis, latex agglutination, coagglutination, and enzyme-linked immunosorbent assay (1, 2, 5, 6, 14, 23). To date, the performance of these tests has been variable, such that they have never received general acceptance.Recently, an immunochromatographic test, the NOW S.pneumoniae urinary antigen test (Binax, Inc., Portland, Maine), h...

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Diagnosis of Pneumococcal Pneumonia in Epidemiological Studies: Evaluation in Kenyan Adults of a Serotype‐Specific Urine Latex Agglutination Assay

Cited by 27 publications

References 38 publications

Diagnosis of Invasive Pneumococcal Infection by Serotype-Specific Urinary Antigen Detection

Diagnosis of Invasive Pneumococcal Infection by Serotype-Specific Urinary Antigen Detection

Diagnostic accuracy of a serotype-specific antigen test in community-acquired pneumonia

Evaluation of a Rapid Immunochromatographic Test for Detection of Streptococcus pneumoniae Antigen in Urine Samples from Adults with Community-Acquired Pneumonia

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