Elsevier

Pathologie Biologie

Volume 54, Issues 8–9, October–November 2006, Pages 498-501
Pathologie Biologie

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

https://doi.org/10.1016/j.patbio.2006.07.031Get rights and content

Abstract

Aim

To evaluate an immunochromatographic membrane test for Streptococcus pneumoniae antigen (Binax NOW, Inverness medical France) applied to pleural fluid samples.

Methods

Binax NOW was applied to the pleural fluids of 69 children with thoracic empyema, in comparison with conventional culture and molecular techniques.

Results

Binax NOW was positive on all 15 pleural fluid samples that yielded S. pneumoniae in culture, on two samples that yielded S. oralis and S. salivarius in culture and on 34 culture-negative samples. Fifteen of these 34 culture-negative samples were retrospectively tested by PCR methods, and 14 were shown to contain S. pneumoniae DNA. Thus, S. pneumoniae was identified by culture in 22% of samples and by Binax NOW in 69% of samples.

Conclusion

Binax NOW may thus be useful for rapid diagnosis of S. pneumoniae thoracic empyema.

Résumé

But de l'étude

Évaluer, sur les liquides pleuraux, le test immunochromatogaphique Binax NOW (Inverness Medical France) pour la recherche d'antigène de Streptococcus pneumoniae.

Méthodes

Binax NOW a été testé sur les liquides pleuraux de 69 enfants hospitalisés pour pleuropneumopathie. Les résultats ont été comparés aux résultats de la culture conventionnelle et des techniques moléculaires.

Résultats

Le test Binax NOW s'est avéré positif pour les 15 liquides pleuraux ayant donné une culture positive à S. pneumoniae, deux liquides pleuraux ayant une culture positive à S. oralis et S. salivarius, et 34 liquides pleuraux ayant une culture négative. Des techniques de PCR (universelle et/ou spécifique S. pneumoniae) effectuées sur 15 de ces 34 liquides pleuraux montrent que 14 contenaient de l'ADN de S. pneumoniae. Donc S. pneumoniae a été diagnostiqué par culture dans 22 % des prélèvements et par le test Binax NOW dans 69 % des prélèvements.

Conclusion

Binax NOW, testé sur les liquides pleuraux, est un outil intéressant pour le diagnostic rapide des pleuropneumopathies à S. pneumoniae.

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.

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