A bedside assay to detect streptococcus pneumoniae in children with empyema
Roxanne E. Strachan BN
Department of Respiratory Medicine, Sydney Children's Hospital, Randwick, Australia
Search for more papers by this authorAnita Cornelius FRACP
Department of Paediatric and Neonatal Intensive Care, Royal Hobart Hospital, Hobart, Australia
Search for more papers by this authorGwendolyn L. Gilbert MD BS, FRACP, FRCPA, M. Bioethics
Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research, Westmead, Australia
Search for more papers by this authorTanya Gulliver FRACP
Paediatric/Respiratory Department, John Hunter Hospital, Newcastle, Australia
Search for more papers by this authorAndrew Martin MD FRACP
Department of General Paediatrics, Princess Margaret Hospital for Children, Subiaco, Australia
Search for more papers by this authorTim McDonald MBBS, FRACP
Department of Paediatrics and Child Health, The Canberra Hospital, Woden, Australia
Search for more papers by this authorGillian M. Nixon MD, MBChB, FRACP
Department of Respiratory and Sleep Medicine, Monash Medical Centre, Ritchie Centre for Baby Health Research, Monash Institute of Medical Research, Clayton, Australia
Search for more papers by this authorRob Roseby MBBS (hons) FRACP
Department of Paediatrics, Alice Springs Hospital, Alice Springs, Australia
Search for more papers by this authorSarath Ranganathan MB, ChB, MRCP, FRCPCH, FRACP, PhD
Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Australia
Search for more papers by this authorHiran Selvadurai MBBS, PhD, FRACP
Department of Respiratory Medicine, Children's Hospital at Westmead, Australia
Search for more papers by this authorGreg Smith MBBS, FRACP
Department of Pulmonary Medicine, Women's and Children's Hospital, North Adelaide, Australia
Search for more papers by this authorManuel Soto-Martinez MD
Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Australia
Search for more papers by this authorSadasivam Suresh MBBS, MRCPCH, FRACP
Department of Respiratory/Sleep Medicine, Mater Children's Hospital, South Brisbane, Australia
Search for more papers by this authorLaurel Teoh BSc (Med), MBBS (Hons), DCH, FRACP
Department of Paediatrics and Child Health, The Canberra Hospital, Woden, Australia
Search for more papers by this authorKiran Thapa BSc
Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research, Westmead, Australia
Search for more papers by this authorClaire E. Wainwright MBBS, MRCP, FRACP, MD
Department of Respiratory Medicine, Royal Children's Hospital, Herston, Australia
Search for more papers by this authorCorresponding Author
Adam Jaffé BSc (Hons), MD, FRCP, FRCPCH, FRACP
Department of Respiratory Medicine, Sydney Children's Hospital, Randwick, Australia
School of Women's and Child Health, University of New South Wales, Sydney, Australia
Associate Professor, Department of Respiratory Medicine, Sydney Children's Hospital, High Street, Randwick, Sydney, NSW 2031, Australia.Search for more papers by this authoron behalf of the Australian Research Network in Empyema (ARNiE)
Search for more papers by this authorRoxanne E. Strachan BN
Department of Respiratory Medicine, Sydney Children's Hospital, Randwick, Australia
Search for more papers by this authorAnita Cornelius FRACP
Department of Paediatric and Neonatal Intensive Care, Royal Hobart Hospital, Hobart, Australia
Search for more papers by this authorGwendolyn L. Gilbert MD BS, FRACP, FRCPA, M. Bioethics
Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research, Westmead, Australia
Search for more papers by this authorTanya Gulliver FRACP
Paediatric/Respiratory Department, John Hunter Hospital, Newcastle, Australia
Search for more papers by this authorAndrew Martin MD FRACP
Department of General Paediatrics, Princess Margaret Hospital for Children, Subiaco, Australia
Search for more papers by this authorTim McDonald MBBS, FRACP
Department of Paediatrics and Child Health, The Canberra Hospital, Woden, Australia
Search for more papers by this authorGillian M. Nixon MD, MBChB, FRACP
Department of Respiratory and Sleep Medicine, Monash Medical Centre, Ritchie Centre for Baby Health Research, Monash Institute of Medical Research, Clayton, Australia
Search for more papers by this authorRob Roseby MBBS (hons) FRACP
Department of Paediatrics, Alice Springs Hospital, Alice Springs, Australia
Search for more papers by this authorSarath Ranganathan MB, ChB, MRCP, FRCPCH, FRACP, PhD
Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Australia
Search for more papers by this authorHiran Selvadurai MBBS, PhD, FRACP
Department of Respiratory Medicine, Children's Hospital at Westmead, Australia
Search for more papers by this authorGreg Smith MBBS, FRACP
Department of Pulmonary Medicine, Women's and Children's Hospital, North Adelaide, Australia
Search for more papers by this authorManuel Soto-Martinez MD
Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Australia
Search for more papers by this authorSadasivam Suresh MBBS, MRCPCH, FRACP
Department of Respiratory/Sleep Medicine, Mater Children's Hospital, South Brisbane, Australia
Search for more papers by this authorLaurel Teoh BSc (Med), MBBS (Hons), DCH, FRACP
Department of Paediatrics and Child Health, The Canberra Hospital, Woden, Australia
Search for more papers by this authorKiran Thapa BSc
Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research, Westmead, Australia
Search for more papers by this authorClaire E. Wainwright MBBS, MRCP, FRACP, MD
Department of Respiratory Medicine, Royal Children's Hospital, Herston, Australia
Search for more papers by this authorCorresponding Author
Adam Jaffé BSc (Hons), MD, FRCP, FRCPCH, FRACP
Department of Respiratory Medicine, Sydney Children's Hospital, Randwick, Australia
School of Women's and Child Health, University of New South Wales, Sydney, Australia
Associate Professor, Department of Respiratory Medicine, Sydney Children's Hospital, High Street, Randwick, Sydney, NSW 2031, Australia.Search for more papers by this authoron behalf of the Australian Research Network in Empyema (ARNiE)
Search for more papers by this authorAbstract
Background
Empyema is a complication of pneumonia, commonly caused by Streptococcus pneumoniae.
Aims
To validate the utility of an immunochromatographic test for the detection of S. pneumoniae antigen in the pleural fluid of children with empyema.
Methods
Empyema patients had blood and pleural fluid cultured, and polymerase chain reaction (PCR) to detect the S. pneumoniae autolysin gene, lytA, in pleural fluid. Pleural fluid was tested using the Binax NOW S. pneumoniae antigen detection assay and compared with lytA PCR results and/or culture in blood or pleural fluid.
Results
S. pneumoniae was detected by PCR in pleural fluid of 68 of 137 (49.6%) patients, by culture in 11 of 135 (8.1%) pleural specimens and 16 of 120 (13.3%) blood specimens. Pleural fluid Binax NOW testing from 130 patients demonstrated a sensitivity of 83.8% and specificity of 93.5% (positive predictive value of 93.4% and negative predictive value of 84.1%).
Conclusions
In pediatric empyema, high predictive values of pleural fluid Binax NOW S. pneumoniae antigen test suggest that this test may help rationalize antibiotic choice in these patients. Pediatr. Pulmonol. 2011; 46:179–183. © 2011 Wiley-Liss, Inc.
REFERENCES
- 1 Strachan RE, Jaffe A. Assessment of the burden of paediatric empyema in Australia. J Paediatr Child Health 2009; 45: 431–436.
- 2 Balfour-Lynn IM, Abrahamson E, Cohen G, Hartley J, King S, Parikh D, Spencer D, Thomson AH, Urquhart D. BTS guidelines for the management of pleural infection in children. Thorax 2005; 60: 1–21.
- 3 Jaffe A, Balfour-Lynn IM. Management of empyema in children. Pediatr Pulmonol 2005; 40: 148–156.
- 4 Cevey-Macherel M, Galetto-Lacour A, Gervaix A, Siegrist CA, Bille J, Bescher-Ninet B, Kaiser L, Krahenbuhl JD, Gehri M. Etiology of community-acquired pneumonia in hospitalized children based on WHO clinical guidelines. Eur J Pediatr 2009; 168: 1429–1436.
- 5 Nascimento-Carvalho CM, Ribeiro CT, Cardoso MR, Barral A, Araujo-Neto CA, Oliveira JR, Sobral LS, Viriato D, Souza AL, Saukkoriipi A, Paldanius M, Vainionpaa R, Leinonen M, Ruuskanen O. The role of respiratory viral infections among children hospitalized for community-acquired pneumonia in a developing country. Pediatr Infect Dis J 2008; 27: 939–941.
- 6 Playfor SD, Smyth AR, Stewart RJ. Increase in incidence of childhood empyema. Thorax 1997; 52: 932.
- 7 Spencer DA, Iqbal SM, Hasan A, Hamilton L. Empyema thoracis is still increasing in UK children. BMJ 2006; 332: 1333.
- 8 Saglani S, Harris KA, Wallis C, Hartley JC. Empyema: the use of broad range 16S rDNA PCR for pathogen detection. Arch Dis Child 2005; 90: 70–73.
- 9 Hernandez-Bou S, Garcia-Garcia JJ, Esteva C, Gene A, Luaces C, Almagro CM. Pediatric parapneumonic pleural effusion: epidemiology, clinical characteristics, and microbiological diagnosis. Pediatr Pulmonol 2009; 44: 1192–1200.
- 10 Le Monnier A, Carbonnelle E, Zahar JR, Le Bourgeois M, Abachin E, Quesne G, Varon E, Descamps P, De Blic J, Scheinmann P, Berche P, Ferroni A. Microbiological diagnosis of empyema in children: comparative evaluations by culture, polymerase chain reaction, and pneumococcal antigen detection in pleural fluids. Clin Infect Dis 2006; 42: 1135–1140.
- 11 Navarro D, Garcia-Maset L, Gimeno C, Escribano A, Garcia-de-Lomas J. Performance of the Binax NOW Streptococcus pneumoniae urinary antigen assay for diagnosis of pneumonia in children with underlying pulmonary diseases in the absence of acute pneumococcal infection. J Clin Microbiol 2004; 42: 4853–4855.
- 12 Ploton C, Freydiere AM, Benito Y, Bendridi N, Mazzocchi C, Bellon G, Vandenesch F. Streptococcus pneumoniae thoracic empyema in children: rapid diagnosis by using the Binax NOW immunochromatographic membrane test in pleural fluids. Pathol Biol (Paris) 2006; 54: 498–501.
- 13 Porcel JM, Ruiz-Gonzalez A, Falguera M, Nogues A, Galindo C, Carratala J, Esquerda A. Contribution of a pleural antigen assay (Binax NOW) to the diagnosis of pneumococcal pneumonia. Chest 2007; 131: 1442–1447.
- 14 Flores JC, Moro MN, Berron S, Jimenez R, Casal J. Usefulness of pneumococcal antigen detection in pleural effusion for the rapid diagnosis of infection by Streptococcus pneumoniae . Eur J Pediatr 2010; 169: 581–584.
- 15 McAvin JC, Reilly PA, Roudabush RM, Barnes WJ, Salmen A, Jackson GW, Beninga KK, Astorga A, McCleskey FK, Huff WB, Niemeyer D, Lohman KL. Sensitive and specific method for rapid identification of Streptococcus pneumoniae using real-time fluorescence PCR. J Clin Microbiol 2001; 39: 3446–3451.
- 16 Poddar SK, Le CT. Bordetella pertussis detection by spectrofluorometry using polymerase chain reaction (PCR) and a molecular beacon probe. Mol Cell Probes 2001; 15: 161–167.
- 17 Nyambat B, Kilgore PE, Yong DE, Anh DD, Chiu CH, Shen X, Jodar L, Ng TL, Bock HL, Hausdorff WP. Survey of childhood empyema in Asia: implications for detecting the unmeasured burden of culture-negative bacterial disease. BMC Infect Dis 2008; 8: 90.
- 18 Lahti E, Mertsola J, Kontiokari T, Eerola E, Ruuskanen O, Jalava J. Pneumolysin polymerase chain reaction for diagnosis of pneumococcal pneumonia and empyema in children. Eur J Clin Microbiol Infect Dis 2006; 25: 783–789.
- 19 Tarrago D, Fenoll A, Sanchez-Tatay D, Arroyo LA, Munoz-Almagro C, Esteva C, Hausdorff WP, Casal J, Obando I. Identification of pneumococcal serotypes from culture-negative clinical specimens by novel real-time PCR. Clin Microbiol Infect 2008; 14: 828–834.
- 20 Kong F, Brown M, Sabananthan A, Zeng X, Gilbert GL. Multiplex PCR-based reverse line blot hybridization assay to identify 23 Streptococcus pneumoniae polysaccharide vaccine serotypes. J Clin Microbiol 2006; 44: 1887–1891.
- 21 Zhou F, Kong F, Tong Z, Gilbert GL. Identification of less-common Streptococcus pneumoniae serotypes by a multiplex PCR-based reverse line blot hybridization assay. J Clin Microbiol 2007; 45: 3411–3415.
- 22 Falguera M, Ruiz-Gonzalez A, Schoenenberger JA, Touzon C, Gazquez I, Galindo C, Porcel JM. Prospective, randomised study to compare empirical treatment versus targeted treatment on the basis of the urine antigen results in hospitalised patients with community-acquired pneumonia. Thorax 2010; 65: 101–106.
Citing Literature
