TY - JOUR
T1 - Enhanced diagnosis of pneumococcal meningitis with use of the binax NOW immunochromatographic test of Streptococcus pneumoniae antigen
T2 - A multisite study
AU - Moïsi, Jennifer C.
AU - Saha, Samir K.
AU - Falade, Adegoke G.
AU - Njanpop-Lafourcade, Berthe Marie
AU - Oundo, Joseph
AU - Zaidi, Anita K.M.
AU - Afroj, Shirin
AU - Bakare, R. A.
AU - Buss, Julie K.
AU - Lasi, Razzaq
AU - Mueller, Judith
AU - Odekanmi, A. A.
AU - Sangarè, Lassana
AU - Scott, J. Anthony G.
AU - Knoll, Maria Deloria
AU - Levine, Orin S.
AU - Gessner, Bradford D.
N1 - Funding Information:
Financial support. PneumoADIP at Johns Hopkins University, which is funded in full by the GAVI Alliance and The Vaccine Fund.
PY - 2009/3/1
Y1 - 2009/3/1
N2 - Background. Accurate etiological diagnosis of meningitis in developing countries is needed, to improve clinical care and to optimize disease-prevention strategies. Cerebrospinal fluid (CSF) culture and latex agglutination testing are currently the standard diagnostic methods but lack sensitivity. Methods. We prospectively assessed the utility of an immunochromatographic test (ICT) of pneumococcal antigen (NOW Streptococcus pneumoniae Antigen Test; Binax), compared with culture, in 5 countries that are conducting bacterial meningitis surveillance in Africa and Asia. Most CSF samples were collected from patients aged 1-59 months. Results. A total of 1173 CSF samples from suspected meningitis cases were included. The ICT results were positive for 68 (99%) of the 69 culture-confirmed pneumococcal meningitis cases and negative for 124 (99%) of 125 culture-confirmed bacterial meningitis cases caused by other pathogens. By use of culture and latex agglutination testing alone, pneumococci were detected in samples from 7.4% of patients in Asia and 15.6% in Africa. The ICT increased pneumococcal detection, resulting in similar identification rates across sites, ranging from 16.2% in Nigeria to 20% in Bangladesh. ICT detection in specimens from culture-negative cases varied according to region (8.5% in Africa vs. 18.8% in Asia; P <.001), prior antibiotic use (24.2% with prior antibiotic use vs. 12.2% without; P <.001), and WBC count (9.0% for WBC count of 10-99 cells/mL, 22.1% for 100-999 cells/mL, and 25.4% for ≥1000 cells/mL; P <.001 by test for trend). Conclusions. The ICT provided substantial benefit over the latex agglutination test and culture at Asian sites but not at African sites. With the addition of the ICT, the proportion of meningitis cases attributable to pneumococci was determined to be similar in Asia and Africa. These results suggest that previous studies have underestimated the proportion of pediatric bacterial meningitis cases caused by pneumococci.
AB - Background. Accurate etiological diagnosis of meningitis in developing countries is needed, to improve clinical care and to optimize disease-prevention strategies. Cerebrospinal fluid (CSF) culture and latex agglutination testing are currently the standard diagnostic methods but lack sensitivity. Methods. We prospectively assessed the utility of an immunochromatographic test (ICT) of pneumococcal antigen (NOW Streptococcus pneumoniae Antigen Test; Binax), compared with culture, in 5 countries that are conducting bacterial meningitis surveillance in Africa and Asia. Most CSF samples were collected from patients aged 1-59 months. Results. A total of 1173 CSF samples from suspected meningitis cases were included. The ICT results were positive for 68 (99%) of the 69 culture-confirmed pneumococcal meningitis cases and negative for 124 (99%) of 125 culture-confirmed bacterial meningitis cases caused by other pathogens. By use of culture and latex agglutination testing alone, pneumococci were detected in samples from 7.4% of patients in Asia and 15.6% in Africa. The ICT increased pneumococcal detection, resulting in similar identification rates across sites, ranging from 16.2% in Nigeria to 20% in Bangladesh. ICT detection in specimens from culture-negative cases varied according to region (8.5% in Africa vs. 18.8% in Asia; P <.001), prior antibiotic use (24.2% with prior antibiotic use vs. 12.2% without; P <.001), and WBC count (9.0% for WBC count of 10-99 cells/mL, 22.1% for 100-999 cells/mL, and 25.4% for ≥1000 cells/mL; P <.001 by test for trend). Conclusions. The ICT provided substantial benefit over the latex agglutination test and culture at Asian sites but not at African sites. With the addition of the ICT, the proportion of meningitis cases attributable to pneumococci was determined to be similar in Asia and Africa. These results suggest that previous studies have underestimated the proportion of pediatric bacterial meningitis cases caused by pneumococci.
UR - http://www.scopus.com/inward/record.url?scp=61849099874&partnerID=8YFLogxK
U2 - 10.1086/596481
DO - 10.1086/596481
M3 - Article
C2 - 19191619
AN - SCOPUS:61849099874
SN - 1058-4838
VL - 48
SP - S49-S56
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - SUPPL. 2
ER -
