Streptococcus pneumoniae thoracic empyema in children: rapid diagnosis by using the Binax NOW immunochromatographic membrane test in pleural fluidsPleuropneumopathie à Streptococcus pneumoniae chez l'enfant : diagnostic rapide avec le test immunochromatographique Binax NOW sur les liquides pleuraux
Introduction
The frequency of thoracic empyema and parapneumonic effusion in children with pneumonia has increased markedly over the last decade, for unknown reasons [1], [2], [3], [4]. Routine bacterial culture is negative in many cases, often because antibiotics have been administered before sampling. Another problem is that Streptococcus pneumoniae, the main causative pathogen in childhood empyema, produces autolysin, a cell-wall enzyme that causes its own lysis.
A recent rapid immunochromatographic membrane assay (Binax NOW Streptococcus pneumoniae test, from Inverness Medical France) detects the C polysaccharide cell wall antigen common to all pneumococcal serotypes. The results are available in 15 min. The test has proven useful for rapid diagnosis of S. pneumoniae pneumonia, based on urine samples [5], [6], [7], [8] and of S. pneumoniae meningitis, based on cerebrospinal fluid samples [9], [10].
The objective of this prospective study was to evaluate the Binax NOW test on pleural fluid, by comparison with conventional culture and molecular techniques, in children hospitalized for thoracic empyema.
Section snippets
Patients
This prospective study focused on pleural fluid samples collected from 69 consecutive children admitted to Debrousse Pediatric Hospital (Lyon, France) for thoracic empyema between January 2003 and April 2005. Median age was 4.1 years (0.7 months to 16.5 years), and 41 of the children were boys. All the children had clinical and radiological evidence of thoracic empyema requiring a pleural fluid puncture.
Binax NOW rapid immunochromatographic Streptococcus pneumoniae antigen test
The Binax NOW test was applied to pleural fluid samples in the same way as recommended by
Results
Between January 2003 and April 2005, a total of 69 pleural fluid samples from children admitted to our institution for thoracic empyema or pleural effusion necessitating thoracocentesis and/or decortication were tested with the Binax NOW test by comparison with conventional culture.
Conventional culture was positive on 20 (29%) of the 69 pleural fluid samples. S. pneumoniae was isolated from 15 samples (22%) Table 1. The other isolates were beta-hemolytic group A streptococci (N = 3),
Discussion
Routine bacterial culture of pleural fluid is often negative in children with pneumonia complicated by thoracic empyema. Here we evaluated the feasibility and performance of the Binax NOW rapid test applied to pleural fluid, in comparison with conventional culture and, when possible, with molecular methods.
When applied to urine samples, Binax NOW is accurate in adults [5], [6], [7], [8], whereas the results are controversial in young children, mainly owing to their high rate of S. pneumoniae
Acknowledgments
We thank David Young for editorial guidance and the technicians of our laboratory for their assistance.
References (22)
- et al.
Increase in incidence of childhood empyema in West Midlands, UK
Lancet
(1997) - et al.
3-year prospective study of a urinary antigen-detection test for Streptococcus pneumoniae in community-acquired pneumonia: utility and clinical impact on the reported etiology
J. Infect. Chemother.
(2004) - et al.
New rapid antigen test for diagnosis of pneumococcal meningitis
Lancet
(2001) - et al.
Use of the NOW Streptococcus pneumoniae urinary antigen test in cerebrospinal fluid for rapid diagnosis of pneumococcal meningitis
Diagn. Microbiol. Infect. Dis.
(2003) - et al.
Molecular diagnosis of recurrent Streptococcus mutans endocarditis by PCR amplification and sequencing
Clin. Microbiol. Infect.
(2001) - et al.
Childhood empyema
Thorax
(1999) - et al.
Clinical characteristics of children with complicated pneumonia caused by Streptococcus pneumoniae
Pediatrics
(2002) - et al.
Clinical features, aetiology and outcome of empyema in children in the north east of England
Thorax
(2004) - et al.
Evaluation of a rapid immunochromatographic assay for detection of Streptococcus pneumoniae antigen in urine samples
Eur. J. Clin. Microbiol. Infect. Dis.
(2001) - et al.
Evaluation of a rapid immunochromatographic test for detection of Streptococcus pneumoniae antigen in urine samples from adults with community-acquired pneumonia
J. Clin. Microbiol.
(2001)
Etiology of community acquired pneumonia among adult patients requiring hospitalization in Taiwan
Respir. Med.
Cited by (34)
Community-Acquired Pneumonia in Childhood
2021, Encyclopedia of Respiratory Medicine, Second EditionPneumococcal Polysaccharide Vaccines
2017, Plotkin's VaccinesPleural effusion with negative culture: a challenge for pneumococcal diagnosis in children
2016, Diagnostic Microbiology and Infectious DiseaseCitation Excerpt :Notably, in 2 patients, the presence of pneumococcal antigen was demonstrated in the PF. Despite the sensitivity of the antigen test, false–positive results have been described, especially with the viridans streptococci group (Alonso-Tarres et al., 2001; Casado Flores et al., 2010; Picazo et al., 2013; Ploton et al., 2006). Indeed, some reports of false–positive results in the urine (Dowell et al., 2001; Hamer et al., 2002; Navarro et al., 2004) as a consequence of carriage among patients may indicate the complexity of the presence and clearance of antigen in biological fluid, suggesting that this issue is far from being completely understood.
Rapid diagnosis of invasive pneumococcal disease in pediatric population
2013, Journal of Microbiological MethodsCitation Excerpt :S. pneumoniae was only identified by conventional culture in 36 of 199 samples. Similar results have been published elsewhere (Casado Flores et al., 2010; Le Monnier et al., 2006; Martinon-Torres et al., 2008; Ploton et al., 2006; Strachan et al., 2010). The potential reasons for the low yield of culture include previous antibiotic therapy, small sample volume, or unsatisfactory conditions of transport and storage (Casado Flores et al., 2010).
Evaluation of a rapid test for the diagnosis of pneumococcal pneumonia
2013, Journal of Microbiological MethodsPneumococcal polysaccharide vaccines
2012, Vaccines: Sixth Edition