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Shumway DO, Kriege K, Wood ST. Discordance of the Urinary and Pleural Fluid Antigen Test and False Positive for Streptococcus pneumoniae in Empyema Secondary to Necrotizing Bacterial Pneumonia. Cureus 2023; 15:e37458. [PMID: 37187652 PMCID: PMC10175080 DOI: 10.7759/cureus.37458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2023] [Indexed: 05/17/2023] Open
Abstract
Empyema is a severe complication of pneumonia with high morbidity and mortality rates. Rapid diagnosis and tailoring of antibiotic therapy are crucial to treatment success for these severe bacterial lung infections. A Streptococcus pneumoniae (S. pneumonia) antigen test drawn from the pleural fluid rather than a urine sample has been found to have equivalent diagnostic utility to the urinary antigen test. Discordance between these tests is rare. We report a case of a 69-year-old female with CT imaging findings consistent with empyema and a bronchopulmonary fistula. A rapid S. pneumonia antigen test was negative from the urinary sample but positive when drawn from a patient's pleural fluid sample. Final pleural fluid cultures resulted in Streptococcus constellatus (S. constellatus). This case demonstrates discordance between the results of urinary and pleural fluid S. pneumoniae antigen tests, representing a potential pitfall in using rapid antigen testing on pleural fluid samples. False positives for the S. pneumoniae antigen in patients with viridans streptococci infections have been documented due to the cross-reactivity of cell wall proteins in different streptococcal species. Physicians encountering bacterial pneumonia of unknown etiology complicated by empyema should understand the potential for discordance and false positives using this diagnostic method.
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Affiliation(s)
| | - Kevin Kriege
- Internal Medicine, Keesler Medical Center, Biloxi, USA
| | - Stuart T Wood
- Infectious Disease, Keesler Medical Center, Biloxi, USA
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Romero Herrero D, Soler-Palacin P, Burgos Cibrian J, Falcó Ferrer V, Anton Pagarolas A, Martin-Gomez MT. Detection of Streptococcus pneumoniae antigen in pleural fluid: usefulness of an immunofluorescence-based lateral flow assay for the diagnosis of pneumococcal pneumonia. Diagn Microbiol Infect Dis 2020; 98:115162. [PMID: 32896751 DOI: 10.1016/j.diagmicrobio.2020.115162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/21/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
The performance of an immunofluorescence-based Streptococcus pneumoniae antigen detection test in pleural fluid (IF-PF) was evaluated. For proven and possible pneumococcal pneumonias global sensitivity and specificity were 92.6 (95 CI 76.6-97.9) and 80 (95 CI 62.7-90.5), respectively, with no significant differences between children and adults. Global diagnostic accuracy of IF-PF was 86% (74.2-93.7), and a substantial k index of concordance with culture/RT-PCR of 0.716 (0.535-0.896). IF-PF might be useful as a rapid complementary test for the etiologic diagnosis of pneumococcal pneumonia.
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Affiliation(s)
| | - Pere Soler-Palacin
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Vicenç Falcó Ferrer
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Haddar CH, Joly J, Carricajo A, Verhoeven PO, Grattard F, Mory O, Begaud E, Germani Y, Cantais A, Pozzetto B. Strategy using a new antigenic test for rapid diagnosis of Streptococcus pneumoniae infection in respiratory samples from children consulting at hospital. BMC Microbiol 2020; 20:79. [PMID: 32264834 PMCID: PMC7137283 DOI: 10.1186/s12866-020-01764-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/23/2020] [Indexed: 02/07/2023] Open
Abstract
Background Despite vaccination programs, Streptococcus pneumoniae remains among the main microorganisms involved in bacterial pneumonia, notably in terms of severity. The prognosis of pneumococcal infections is conditioned in part by the precocity of the diagnosis. The aim of this study was to evaluate the impact of a Rapid Diagnostic Test (RDT) targeting cell wall polysaccharide of Streptococcus pneumoniae and performed directly in respiratory samples, on the strategy of diagnosis of respiratory pneumococcal infections in children. Results Upper-respiratory tract samples from 196 children consulting at hospital for respiratory infection were tested for detecting S. pneumoniae using a newly-designed RDT (PneumoResp, Biospeedia), a semi-quantitative culture and two PCR assays. If positive on fluidized undiluted specimen, the RDT was repeated on 1:100-diluted sample. The RDT was found highly specific when tested on non-S. pneumoniae strains. By comparison to culture and PCR assays, the RDT on undiluted secretions exhibited a sensitivity (Se) and negative predictive value (NPV) of more than 98%. By comparison to criteria of S. pneumoniae pneumonia combining typical symptoms, X-ray image, and culture ≥107 CFU/ml, the Se and NPV of RDT on diluted specimens were 100% in both cases. Conclusions In case of negative result, the excellent NPV of RDT on undiluted secretions allows excluding S. pneumoniae pneumonia. In case of positive result, the excellent sensitivity of RDT on diluted secretions for the diagnosis of S. pneumoniae pneumonia allows proposing a suitable antimicrobial treatment at day 0.
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Affiliation(s)
- Cyrille H Haddar
- GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes), University of Lyon, 42023, Saint-Etienne, France.,BioSpeedia, Institut Pasteur, 75015, Paris, France
| | - Johan Joly
- Laboratory of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, 42055, Saint-Etienne Cedex 02, France
| | - Anne Carricajo
- GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes), University of Lyon, 42023, Saint-Etienne, France.,Laboratory of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, 42055, Saint-Etienne Cedex 02, France
| | - Paul O Verhoeven
- GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes), University of Lyon, 42023, Saint-Etienne, France.,Laboratory of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, 42055, Saint-Etienne Cedex 02, France
| | - Florence Grattard
- GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes), University of Lyon, 42023, Saint-Etienne, France.,Laboratory of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, 42055, Saint-Etienne Cedex 02, France
| | - Olivier Mory
- Pediatric Emergency Department, University Hospital of Saint-Etienne, 42055, Saint-Etienne Cedex 02, France
| | | | - Yves Germani
- BioSpeedia, Institut Pasteur, 75015, Paris, France
| | - Aymeric Cantais
- Pediatric Emergency Department, University Hospital of Saint-Etienne, 42055, Saint-Etienne Cedex 02, France
| | - Bruno Pozzetto
- GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes), University of Lyon, 42023, Saint-Etienne, France. .,Laboratory of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, 42055, Saint-Etienne Cedex 02, France.
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