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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Use of a rapid test of pneumococcal colonization density to diagnose pneumococcal pneumonia
Clinical Infectious Diseases, Volume 54, No. 5, Year 2012
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Description
Background. There is major need for a more sensitive assay for the diagnosis of pneumococcal community-acquired pneumonia (CAP). We hypothesized that pneumococcal nasopharyngeal (NP) proliferation may lead to microaspiration followed by pneumonia. We therefore tested a quantitative lytA real-time polymerase chain reaction (rtPCR) on NP swab samples from patients with pneumonia and controls. Methods. In the absence of a sensitive reference standard, a composite diagnostic standard for pneumococcal pneumonia was considered positive in South African human immunodeficiency virus (HIV)-infected adults hospitalized with radiographically confirmed CAP, if blood culture, induced good-quality sputum culture, Gram stain, or urinary Binax demonstrated pneumococci. Results of quantitative lytA rtPCR in NP swab samples were compared with quantitative colony counts in patients with CAP and 300 HIV-infected asymptomatic controls. Results. Pneumococci were the leading pathogen identified in 76 of 280 patients with CAP (27.1%) using the composite diagnostic standard. NP colonization density measured by lytA rtPCR correlated with quantitative cultures (r = 0.67; P <. 001). The mean lytA rtPCR copy number in patients with pneumococcal pneumonia was 6.0 log10 copies/mL, compared with patients with CAP outside the composite standard (2.7 log10 copies/mL; P <. 001) and asymptomatic controls (0.8 log10 copies/mL; P <. 001). A lytA rtPCR density ≥8000 copies/mL had a sensitivity of 82.2% and a specificity of 92.0% for distinguishing pneumococcal CAP from asymptomatic colonization. The proportion of CAP cases attributable to pneumococcus increased from 27.1% to 52.5% using that cutoff.Conclusions.A rapid molecular assay of NP pneumococcal density performed on an easily available specimen may significantly increase pneumococcal pneumonia diagnoses in adults. © The Author 2012. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3275757/bin/supp_54_5_601__index.html
https://efashare.b-cdn.net/share/pmc/articles/PMC3275757/bin/supp_cir859_Figure_1a_and_1b_powerpoint.ppt
Authors & Co-Authors
Albrich, Werner Christian
South Africa, Johannesburg
Respiratory and Meningeal Pathogens Research Unit
Switzerland, Aarau
Kantonsspital Aarau
Madhi, Shabir A.
South Africa, Johannesburg
Respiratory and Meningeal Pathogens Research Unit
South Africa, Pretoria
National Research Foundation
Adrian, Peter V.
South Africa, Johannesburg
Respiratory and Meningeal Pathogens Research Unit
South Africa, Pretoria
National Research Foundation
van Niekerk, A. B.N.
South Africa, Johannesburg
Respiratory and Meningeal Pathogens Research Unit
Mareletsi, T.
South Africa, Johannesburg
Respiratory and Meningeal Pathogens Research Unit
Cutland, Clare Louise
South Africa, Johannesburg
Respiratory and Meningeal Pathogens Research Unit
South Africa, Pretoria
National Research Foundation
Wong, Michelle Lianne
South Africa, Johannesburg
University of the Witwatersrand
Khoosal, Manikant
South Africa, Johannesburg
National Health Laboratory Service
Karstaedt, Alan S.
South Africa, Johannesburg
University of the Witwatersrand
Zhao, P.
United States, Pearl River
Pfizer Vaccine Research
Deatly, Anne M.
United States, Pearl River
Pfizer Vaccine Research
Sidhu, Mohinder S.
United States, Pearl River
Pfizer Vaccine Research
Jansen, Kathrin Ute
United States, Pearl River
Pfizer Vaccine Research
Klugman, K. P.
South Africa, Johannesburg
Respiratory and Meningeal Pathogens Research Unit
United States, Atlanta
Rollins School of Public Health
United States, Atlanta
Emory University
Statistics
Citations: 145
Authors: 14
Affiliations: 8
Identifiers
Doi:
10.1093/cid/cir859
ISSN:
10584838
e-ISSN:
15376591
Research Areas
Infectious Diseases
Study Approach
Quantitative