Use of Counter and rocket immunoelectrophoresis in acute respiratory infections due to Streptococcus pneumoniae.

Abstract

sYNoPsis The use of Counter immunoelectrophoresis (CIE) for the detection of pneumococcal capsular antigen in the sputum and serum of patients suffering from acute respiratory infections is described. The CIE of sputum gave positive results in 224 (99 %) out of 225 samples in which Streptococcus pneumoniae was isolated by cultural techniques, and in 23 (9 %) out of 262 samples in which no or other potential pathogens had been isolated. In the detection of capsular antigen in serum, CIE was positive in 32 (35 %) out of 92 pneumonia cases and was associated with an increase in mortality.In the clinical management of pneumonia where the patient receives antimicrobial therapy before the causal organism has been identified, a specific bacteriological diagnosis is frequently rendered impossible because of the growth of such replacement organisms as Escherichia coli and Klebsiella species (Spencer and Philp, 1973). Since the detection of antibodies or polysaccharide capsular antigens might be of value in this situation, the use of Electrosynerese (Bussard, 1959), a development from the technique of Lang and Haas (1957), or Counter immunoelectrophoresis (CIE), as it is more commonly termed, has been investigated. The present report is primarily concerned with the diagnostic and prognostic use of this technique in pneumonia due to Streptococcus pneumoniae. Patients and Methods PATIENTSA group of 225 consecutive patients, in whom Str. pneumoniae had been isolated from the sputum as the potential pathogen, was balanced with a control group of 262 patients from whom another or no potential pathogen had been isolated. The first group was subdivided into three categories: (1) patients with clinical pneumonia confirmed by chest x-rays, (2) patients with exacerbations of chronic lung diseases, eg, bronchitis, asthma, and Received for publication 6 August 1975 bronchiectasis, and (3) surgical postoperative patients who had developed a productive cough but did not fall into the previous two categories. SAMPLESSputum and serum were collected from the patients as soon as the clinical diagnosis had been made. The sputa were cultured on blood agar under carbon dioxide at 37°C. These were read after overnight incubation, and potential pathogens were identified by standard methods (Cowan and Steel, 1974). Very small numbers of potential pathogens found only in the inoculation well were not regarded as significant. IMMUNOELECTROPHORESISCounter Immunoelectrophoresis (CIE) This was performed with a method based on that of Dorff et al (1971). The stock buffer used was barbitone/sodium barbitone, pH 8-2, and microscope slides were covered with 0 9% agarose (Miles-Seravac Ltd, Maidenhead, Berks) in halfstrength buffer sufficient to give a depth of 1 mm of agarose. Ten ,ul amounts of antibody or test fluid were employed and a constant voltage of 20 V per cm was applied for one hour at room temperature. After electrophoresis the gel was washed in 5% sodium citrate for 15 minutes and examined by reflected light for lines of precipitation. Ge...

Diagnosis of acute bacterial pneumonia in Nigerian children. Value of needle aspiration of lung of countercurrent immunoelectrophoresis.

“…The 24% rate of detection of pneumococcal antigen in the serum of culture-positive cases of pneumococcal pneumonia was slightly lower than that of other studies (Tugwell and Greenwood, 1975;Spencer and Savage, 1976;Michaels and Poziviak, 1976). The real value of the technique lies in its ability to detect antigen in the absence of any viable organisms.…”

“…3 patients were diagnosed by CIE when cultures were negative. Bacterial antigen has been shown to persist for several days after the successful treatment of bacterial pneumonia with antibiotics (Spencer and Savage, 1976), whereas bacterial cultures are notoriously susceptible to prior exposure of patients to antibiotics. It is in these antibiotic-treated patients that CIE may prove of the greatest value.…”

“…The presence of pneumococcal antigen in the serum of a patient with a respiratory tract infection implies pneumococcal pneumonia (Tugwell and Greenwood, 1975;Spencer and Savage, 1976). The relevance of antigenaemia in other bacterial infections of the respiratory tract has not been thoroughly evaluated.…”

Rapid Diagnosis of Community-acquired Bacterial Pneumonia

“…Counterimmunoelectrophoresis (CIE) and coagglutination are 2 techniques that have been used to detect the presence of bacterial antigens in clinical specimens. The results of earlier studies employing these techniques in sputum have been encouraging (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). However, in each of the previous studies the investigation has been limited to the detection of pneumococcal antigen.…”

Außerhalb des Krankenhauses erworbene Pneumonie (community acquired pneumonia CAP)

“…Die Ursachen der Aufnahme im Spital mit Pneumonie unter laufender Antibiotikatherapie könnte neben dem Versagen der Antibiotikatherapie (wobei eine Therapiedauer von 1-2 Tagen für diese Klassifikation kurz ist) auch eine mangelnde ambulante Überwachung und Unsicherheiten hinsichtlich der Compliance sein. Im Gegensatz zu anderen Arbeiten [35,49], bei denen die "CAP nach ambulanter Vortherapie" eher älter waren, waren sie in unserer Analyse eher jünger als die primär aufgenommenen PatientInnen. Das kann daran liegen, dass die Patienten in der Arbeit von Minogue [35] Therapie sondern zum Versagen einer extrahospitalen antibiotischen Therapie kam, zudem war der durchschnittliche Pneumonie Severity Index bei unseren hospitalisierten Patienten über 90.…”