Multiplex Urinary Antigen Detection for 13 Streptococcus pneumoniae Serotypes Improves Diagnosis of Pneumococcal Pneumonia in South African HIV-Infected Adults

Albrich, Werner C.; Pride, Michael W.; Madhi, Shabir А.; Callahan, J. Sean; Adrian, Peter V.; French, R. C.; Niekerk, Nadia van; Sebastian, Shite; Souza, Victor Costa de; Telles, Jean-Noël; Paranhos-Baccalà, Gláucia; Jansen, Kathrin U.; Klugman, Keith P.

doi:10.1128/jcm.01573-16

Cited by 9 publications

(8 citation statements)

References 49 publications

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“…Further studies are needed to describe the serotype distribution of pneumococcal pneumonia in Malawi, to determine whether targeted vaccination programs of at-risk groups may be beneficial to tackle the persistent burden of adult disease. Recently developed urinary assays that can detect serotype-specific antigens in noninvasive pneumococcal pneumonia may provide a more comprehensive description (47).…”

Section: Discussionmentioning

confidence: 99%

Etiology and Risk Factors for Mortality in an Adult Community-acquired Pneumonia Cohort in Malawi

Aston

Jary

et al. 2019

Am J Respir Crit Care Med

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Rationale: In the context of rapid antiretroviral therapy rollout and an increasing burden of noncommunicable diseases, there are few contemporary data describing the etiology and outcome of community-acquired pneumonia (CAP) in sub-Saharan Africa. Objectives: To describe the current etiology of CAP in Malawi and identify risk factors for mortality. Methods: We conducted a prospective observational study of adults hospitalized with CAP to a teaching hospital in Blantyre, Malawi. Etiology was defined by blood culture, Streptococcus pneumoniae urinary antigen detection, sputum mycobacterial culture and Xpert MTB/RIF, and nasopharyngeal aspirate multiplex PCR. Measurements and Main Results: In 459 patients (285 [62.1%] males; median age, 34.7 [interquartile range, 29.4–41.9] yr), 30-day mortality was 14.6% (64/439) and associated with male sex (adjusted odds ratio, 2.60 [95% confidence interval, 1.17–5.78]), symptom duration greater than 7 days (2.78 [1.40–5.54]), tachycardia (2.99 [1.48–6.06]), hypoxemia (4.40 [2.03–9.51]), and inability to stand (3.59 [1.72–7.50]). HIV was common (355/453; 78.4%), frequently newly diagnosed (124/355; 34.9%), but not associated with mortality. S. pneumoniae (98/458; 21.4%) and Mycobacterium tuberculosis (75/326; 23.0%) were the most frequently identified pathogens. Viral infection occurred in 32.6% (148/454) with influenza (40/454; 8.8%) most common. Bacterial–viral coinfection occurred in 9.1% (28/307). Detection of M. tuberculosis was associated with mortality (adjusted odds ratio, 2.44 [1.19–5.01]). Conclusions: In the antiretroviral therapy era, CAP in Malawi remains predominantly HIV associated, with a large proportion attributable to potentially vaccine-preventable pathogens. Strategies to increase early detection and treatment of tuberculosis and improve supportive care, in particular the correction of hypoxemia, should be evaluated in clinical trials to address CAP-associated mortality.

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Section: Discussionmentioning

confidence: 99%

Etiology and Risk Factors for Mortality in an Adult Community-acquired Pneumonia Cohort in Malawi

Aston

Jary

et al. 2019

Am J Respir Crit Care Med

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“…68 A South African study confirmed that ss-UAD has high diagnostic accuracy to detect pneumococcal pneumonia and simultaneous detection of PCV13 serotypes in HIV-infected adults in South Africa, offering a potentially useful tool to determine pneumococcal pneumonia in this population. 69 Of note is the persistence of ST3 as one of the most prevalent vaccine serotypes both before and after the PCV13 infant programme. A recent global genomic analysis of ST3 has identified a new antibiotic-resistant clade which is replacing the less resistant clade.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Non-invasive pneumococcal pneumonia due to vaccine serotypes: A systematic review and meta-analysis

et al. 2022

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Background Non-invasive pneumococcal pneumonia causes significant morbidity and mortality in older adults. Understanding pneumococcal sero-epidemiology in adults ≥50 years is necessary to inform vaccination policies and the updating of pneumococcal vaccines. MethodsWe conducted a systematic review and random-effects meta-analysis to determine the proportion of community-acquired pneumonia (CAP) in people ≥50 years due to pneumococcus and the proportion caused by pneumococcal vaccine serotypes. We searched MEDLINE, EMBASE and PubMed from 1 January 1990 to 30 March 2021. Heterogeneity was explored by subgroup analysis according to a) patient group (stratified versus age) and depth of testing, b) detection/serotyping method, and c) continent. The protocol is registered with PROSPERO (CRD42020192002).Findings Twenty-eight studies were included (34,216 patients). In the period 1−5 years after introduction of childhood PCV10/13 immunisation, 18% of CAP cases (95% CI 13−24%) were attributable to pneumococcus, with 49% (43−54%) of pneumococcal CAP due to PCV13 serotypes. The estimated proportion of pneumococcal CAP was highest in one study that used 24-valent serotype-specific urinary-antigen detection (ss-UAD)(30% [28−31%]), followed by studies based on diagnostic serology (28% [24−33%]), PCR (26% [15−37%]), ss-UAD14 (17% [13−22%]), and culture alone (14% [10−19%]). A higher estimate was observed in Europe (26% [21−30%] than North America (11% [9 −12%](p<0¢001). PCV13-serotype estimates were also influenced by serotyping methods.Interpretation Non-invasive pneumococcal CAP and vaccine-type pneumococcal CAP remains a burden in older adults despite widespread introduction of pneumococcal infant immunisation. Studies heavily reliant on ss-UADs restricted to vaccine-type serotypes may overestimate the proportion of potentially vaccine-preventable pneumococcal pneumonia. Sero-epidemiological data from low-income countries are lacking.

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“…Sputum is generally considered a better sample as compared to NP swabs (sensitivity 78-94% vs 44-81%, specificity 80-87% vs 80-99%, AUC-ROC 0,80-0.96 vs 0.80-0.86) [22][23] [24]. However, the few reports which have compared rtPCR-lytA in sputum and NP samples came to conflicting results: two of them found that sputum had higher sensitivity [22] [24] while another one observed a comparable diagnostic performance between sputum and NP swabs [23]. However, obtaining a good-quality sputum is not easy as many pneumonia patients have a dry cough and are unable to produce sputum.…”

Section: Discussionmentioning

confidence: 99%

“…In our cohort adequate sputum could be obtained in less than one third of cases and P-CAP could be diagnosed using sputum as diagnostic test in only 10% of cases. As previously described [23], NP swab may be preferable for the diagnosis of P-CAP as it can be collected in all patients.…”

Section: Discussionmentioning

confidence: 99%

Improvement of pneumococcal pneumonia diagnosis using quantitative real-time PCR targeting lytA in adult patients: a prospective cohort study

Boix-Palop

Obradors

Xercavins³

et al. 2022

Clinical Microbiology and Infection

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Multiplex Urinary Antigen Detection for 13 Streptococcus pneumoniae Serotypes Improves Diagnosis of Pneumococcal Pneumonia in South African HIV-Infected Adults

Cited by 9 publications

References 49 publications

Etiology and Risk Factors for Mortality in an Adult Community-acquired Pneumonia Cohort in Malawi

Etiology and Risk Factors for Mortality in an Adult Community-acquired Pneumonia Cohort in Malawi

Non-invasive pneumococcal pneumonia due to vaccine serotypes: A systematic review and meta-analysis

Improvement of pneumococcal pneumonia diagnosis using quantitative real-time PCR targeting lytA in adult patients: a prospective cohort study

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