Rapid Detection of Streptococcus pyogenes in Pleural Fluid Samples from Pediatric Patients with Empyema

Zheng, Xiaotian; O'Leary, Amanda; Uhl, James R.; Patel, Robin; Shulman, Stanford T.

doi:10.1128/jcm.00603-12

Cited by 15 publications

(6 citation statements)

References 12 publications

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“…Our study also confirms the usefulness of molecular assays and other techniques such as the rapid antigen test for diagnosing GAS in pleural effusion, especially when antibiotics have been given before admission 13 14 . Emm genotypes were identified in less than half of the GAS strains isolated.…”

Section: Discussionsupporting

confidence: 79%

“…The microbiological diagnosis of GAS empyema was based on the identification of GAS in pleural fluid (culture, GAS rapid antigen test13 or 16S rRNA PCR sequencing14) or in a blood culture. The microbiological diagnosis of S. pneumoniae empyema was based on the identification of S. pneumoniae in pleural fluid (culture, pneumococcal soluble antigen, 16S rRNA PCR sequencing or S. pneumoniae -specific PCR) or in a blood culture.…”

Section: Methodsmentioning

confidence: 99%

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When should clinicians suspect group Astreptococcusempyema in children? A multicentre case–control study in French tertiary care centres

et al. 2016

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BackgroundThe incidence of invasive group A streptococcus (GAS) infections is increasing worldwide, whereas there has been a dramatic decrease in pneumococcal invasive diseases. Few data describing GAS pleural empyema in children are available.ObjectiveTo describe the clinical and microbiological features, management and outcome of GAS pleural empyema in children and compare them with those of pneumococcal empyema.Design, setting and patientsFifty children admitted for GAS pleural empyema between January 2006 and May 2013 to 8 hospitals participating in a national pneumonia survey were included in a descriptive study and matched by age and centre with 50 children with pneumococcal empyema.ResultsThe median age of the children with GAS pleural empyema was 2 (range 0.1–7.6) years. Eighteen children (36%) had at least one risk factor for invasive GAS infection (corticosteroid use and/or current varicella). On admission, 37 patients (74%) had signs of circulatory failure, and 31 (62%) had a rash. GAS was isolated from 49/50 pleural fluid samples and from one blood culture. The commonest GAS genotype was emm1 (n=17/22). Two children died (4%). Children with GAS empyema presented more frequently with a rash (p<0.01), signs of circulatory failure (p=0.01) and respiratory disorders (p=0.02) and with low leucocyte levels (p=0.04) than children with pneumococcal empyema. Intensive care unit admissions (p<0.01), drainage procedures (p=0.04) and short-term complications (p=0.01) were also more frequent in patients with GAS empyema.ConclusionsPleural empyema following varicella or presenting with rash, signs of circulatory failure and leucopenia may be due to GAS. These features should prompt the addition to treatment of an antitoxin drug, such as clindamycin.

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Section: Discussionsupporting

confidence: 79%

Section: Methodsmentioning

confidence: 99%

When should clinicians suspect group Astreptococcusempyema in children? A multicentre case–control study in French tertiary care centres

et al. 2016

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“…All these data confirmed that RADTs designed for GAS pharyngitis can be used to diagnose extrapharyngeal GAS infection accurately. A single study on 120 pleural fluid samples but limited to 10 GAS-positive specimens from pediatric patients has already been published (17). Sensitivities of 100%, 90%, and 10% have been reported for GAS PCR, RADTs, and culture, respectively.…”

Section: Discussionmentioning

confidence: 99%

Reassessment of the Role of Rapid Antigen Detection Tests in Diagnosis of Invasive Group A Streptococcal Infections

et al. 2016

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i Rapid antigen detection tests (RADTs) for group A streptococci (GAS) are widely used for diagnosing acute pharyngitis, which has led to a considerable reduction in antibiotic prescriptions over the past decade. Beyond this intended use, their reassessment on invasive samples may be relevant in the management of life-threatening GAS infections. To this end, we evaluated the performances of three RADTs, culture, GAS PCR, and 16S rRNA gene PCR assays, and compared them with a composite gold standard (GAS-PCR assay and/or culture) for the diagnosis of severe GAS infection. A total of 192 specimens from deep-tissue (mostly normally sterile) sites enriched for 75 GAS-positive samples were enrolled in the study. The three evaluated RADTs showed sensitivities ranging from 88.0% to 94.7% versus 98.7% for GAS PCR, 84% for 16S rRNA gene PCR, and 77.3% for culture. The sensitivities of the ImmunoCard STAT! Strep A test (Meridian Bioscience) and the NADAL Strep A strip (Nal Von Minden) were similar to that of GAS PCR (P ‫؍‬ 0.25 and 0.03, respectively) and higher than that of culture (P ‫؍‬ 0.001 and 0.006, respectively), whereas the SD Bioline Strep A test strip (Standard Diagnostics) showed a performance similar to that of culture (P ‫؍‬ 0.02). The three RADTs detected 10 distinct emm types, including a predominance of emm 1 (33.3%), emm 89 (10.6%), and emm 12 (7.6%). No false-positive results were observed, leading to a specificity of 100% for all the evaluated RADTs. The GAS RADTs turned out to be sensitive, specific, and easy-to-use tools that may aid in the management of invasive GAS infections in 24/7 point-of-care laboratories by enabling early diagnosis and focused therapy. Group A streptococci (GAS) are common bacterial pathogens responsible for mild diseases, such as pharyngitis, and invasive and life-threatening infections resulting from their dissemination into deep tissues. The worrying increase in the prevalence of these severe infections and their high fatality rates emphasize the need for rapid diagnostic tests to aid in patient management (1, 2).Over the past 2 decades, manufacturers have developed immunochromatographic rapid antigen detection tests (RADTs) that detect the polysaccharide C cell-wall antigen of bacteria. These tests are now widely used for diagnosing pharyngitis in pediatric outpatient clinics and private practices, which has considerably reduced the number of antibiotic prescriptions and resulted in fewer throat cultures performed by laboratories (3-5).Extending their indication beyond this intended use, namely, on deep-seated samples, may reduce delays in the diagnosis of invasive infections. To this end, we evaluated the performances of three commercially available RADTs approved for pharyngitis in the diagnosis of invasive GAS infections and compared them with those of conventional culture and molecular techniques. MATERIALS AND METHODSPatients and clinical specimens. This survey was conducted by three teaching hospitals (in Lyon, Grenoble, and Saint-Etienne, France) between May 2013 a...

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“…Point-of-care rapid antigen tests for sore throat, that recognise the carbohydrate group antigen of S . pyogenes , can be adapted for use in iGAS infection 6 , 7 but thus far no protein-based targets have been identified.…”

Section: Introductionmentioning

confidence: 99%

Proteomic analysis at the sites of clinical infection with invasive Streptococcus pyogenes

Edwards

Pyzio

Gierula

et al. 2018

Sci Rep

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Invasive Streptococcus pyogenes infections are rare, with often-unexplained severity. Prompt diagnosis is desirable, as deaths can occur rapidly following onset and there is an increased, but preventable, risk to contacts. Here, proteomic analyses of clinical samples from invasive human S. pyogenes infections were undertaken to determine if novel diagnostic targets could be detected, and to augment our understanding of disease pathogenesis. Fluid samples from 17 patients with confirmed invasive S. pyogenes infection (empyema, septic arthritis, necrotising fasciitis) were analysed by proteomics for streptococcal and human proteins; 16/17 samples had detectable S. pyogenes DNA. Nineteen unique S. pyogenes proteins were identified in just 6/17 samples, and 15 of these were found in a single pleural fluid sample including streptococcal inhibitor of complement, trigger factor, and phosphoglycerate kinase. In contrast, 469 human proteins were detected in patient fluids, 177 (38%) of which could be identified as neutrophil proteins, including alpha enolase and lactotransferrin which, together, were found in all 17 samples. Our data suggest that streptococcal proteins are difficult to detect in infected fluid samples. A vast array of human proteins associated with leukocyte activity are, however, present in samples that deserve further evaluation as potential biomarkers of infection.

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Rapid Detection of Streptococcus pyogenes in Pleural Fluid Samples from Pediatric Patients with Empyema

Cited by 15 publications

References 12 publications

When should clinicians suspect group Astreptococcusempyema in children? A multicentre case–control study in French tertiary care centres

When should clinicians suspect group Astreptococcusempyema in children? A multicentre case–control study in French tertiary care centres

Reassessment of the Role of Rapid Antigen Detection Tests in Diagnosis of Invasive Group A Streptococcal Infections

Proteomic analysis at the sites of clinical infection with invasive Streptococcus pyogenes

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