Diagnosis of Streptococcus pneumoniae lower respiratory infection in hospitalized children by culture, polymerase chain reaction, serological testing, and urinary antigen detection.

Ian C. Michelow, Juanita Lozano, Kurt Olsen, Collin Goto, Nancy K. Rollins, Faryal Ghaffar, Violeta Rodriguez-Cerrato, Maija Leinonen, George H. McCracken

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Abstract

A prospective study of 154 consecutive high-risk hospitalized children with lower respiratory infections was conducted to determine the clinical utility of a pneumolysin-based polymerase chain reaction (PCR) assay compared with blood and pleural fluid cultures and serological and urinary antigen tests to determine the incidence of Streptococcus pneumoniae. Whole blood, buffy coat, or plasma samples from 67 children (44%) tested positive by PCR. Sensitivity was 100% among 11 promptly tested culture-confirmed children and specificity was 95% among control subjects. Age, prior oral antibiotic therapy, and pneumococcal nasopharyngeal colonization did not influence PCR results, whereas several surrogates of disease severity were associated with positive tests. Although serological and urinary antigen tests had comparable sensitivity, specificity varied among infected children, and statistical agreement among all assays was limited. These findings support the use of PCR tests to evaluate the protective efficacy of pneumococcal conjugate vaccines and to identify promptly children with pretreated or nonbacteremic pneumococcal lower respiratory infections.

Original languageEnglish (US)
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America
Volume34
Issue number1
DOIs
StatePublished - Jan 1 2002

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Hospitalized Child
Streptococcus pneumoniae
Respiratory Tract Infections
Antigens
Polymerase Chain Reaction
Blood Buffy Coat
Conjugate Vaccines
Pneumococcal Vaccines
Prospective Studies
Anti-Bacterial Agents
Sensitivity and Specificity
Incidence
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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abstract = "A prospective study of 154 consecutive high-risk hospitalized children with lower respiratory infections was conducted to determine the clinical utility of a pneumolysin-based polymerase chain reaction (PCR) assay compared with blood and pleural fluid cultures and serological and urinary antigen tests to determine the incidence of Streptococcus pneumoniae. Whole blood, buffy coat, or plasma samples from 67 children (44{\%}) tested positive by PCR. Sensitivity was 100{\%} among 11 promptly tested culture-confirmed children and specificity was 95{\%} among control subjects. Age, prior oral antibiotic therapy, and pneumococcal nasopharyngeal colonization did not influence PCR results, whereas several surrogates of disease severity were associated with positive tests. Although serological and urinary antigen tests had comparable sensitivity, specificity varied among infected children, and statistical agreement among all assays was limited. These findings support the use of PCR tests to evaluate the protective efficacy of pneumococcal conjugate vaccines and to identify promptly children with pretreated or nonbacteremic pneumococcal lower respiratory infections.",
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AU - Rollins, Nancy K.

AU - Ghaffar, Faryal

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