J Clin Microbiol. 2016 Nov 9. pii: JCM.01573-16. [Epub ahead of print]

Multiplex urinary antigen detection for 13 Streptococcus pneumoniae serotypes improves diagnosis of pneumococcal pneumonia in South African HIV-infected adults.

Albrich WC1,2, Pride MW3, Madhi SA4,5, Callahan J6, Adrian PV4,5, French R7, van Niekerk N4, Sebastian S3, Souza V3, Telles JN8, Paranhos-Baccalà G8, Jansen KU3, Klugman KP4,5,9.

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Abstract

BACKGROUND:

A serotype-specific urinary antigen detection assay (UAD) for 13 serotypes included in the pneumococcal conjugate vaccine (PCV13) was recently reported as a useful diagnostic tool for pneumococcal pneumonia. We aimed to assess the diagnostic accuracy of the UAD in HIV-infected South African adults.

METHODS:

Urine specimens from a well-defined cohort of HIV-infected South African adults with pneumonia were evaluated retrospectively in the UAD assay. Pneumonia was considered pneumococcal if either sputum Gram stain, sputum culture, blood culture or immunochromatographic (ICT) BinaxNow® S. pneumoniae test (composite diagnostic) were positive.

RESULTS:

Among 235 enrolled pneumonia patients, the UAD was more frequently positive (104 [44.3%]) than the composite diagnostic (71 [30.2%], p<0.001) and increased the pneumococcal etiology from 30.2% by an additional 22.6% to 52.8%. The UAD assay detected more pneumococcal etiologies (45.0%) than the serotype-independent ICT (23.4%, p<0.001). The UAD identified 6/7 patients with PCV13 serotype bacteremia without misclassification of bacteremia episodes due to non-PCV13 serotypes. The UAD was positive in 5.1% of asymptomatic HIV-infected persons with higher rates among those with nasopharyngeal carriage. Concordance between serotypes identified by UAD and by Quellung and PCR serotyping was 70/86 (81.4%). The UAD identified the dominant serotype in multiple serotype carriage.

CONCLUSIONS:

This study confirms the utility of the UAD assay in HIV-infected adults comparing favourably with other diagnostic tests. A high-valent UAD may become a new standard for detection of pneumococcal pneumonia in adults. Prior to PCV introduction, at least 53% of pneumonias were due to pneumococcus in HIV-infected South African adults.

Copyright © 2016, American Society for Microbiology. All Rights Reserved.

PMID: 27847374 DOI: 10.1128/JCM.01573-16

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