title: Rapid diagnosis of pneumococcal pneumonia among HIV-infected adults with urine antigen detection.
abstract: OBJECTIVE
  Streptococcus pneumoniae is the leading cause of bacterial pneumonia and associated bacteremia during HIV infection. Rapid diagnostic assays may limit inappropriate therapy.
  
  
  METHODS
  Clinical signs and symptoms and sera and urine were collected prospectively from 70 adults with pneumococcal pneumonia, including 47 with HIV co-infection. Pneumococcal C-polysaccharide antigen was detected in urine using the Binax immunochromatographic test (ICT). A systematic review of 24 published studies was conducted.
  
  
  RESULTS
  Clinical symptoms, signs, and laboratory parameters except leukocytosis, were similar in HIV-infected and HIV-seronegative pneumonia. The performance of the urine antigen ICT was independent of HIV-status (sensitivity 81%, specificity 98%, positive (PPV) and negative predictive values (NPV) 98%, and 82%, respectively). The sensitivity of sputum Gram's stain was 58% (34/59) with sputum unable to be provided by 16%. The CRP response was identical in HIV-infected (mean+/-SD) 133+/-88 vs. seronegative 135+/-104 mg/L (p=0.9). In the systematic review, the ICT performance revealed 74% sensitivity (95% CI 72-77%) and 94% specificity (95% CI 93-95%). Urine antigen testing increases etiologic diagnosis by 23% (range: 10-59%) when testing adults with community acquired pneumonia of unknown etiology.
  
  
  CONCLUSIONS
  Urinary antigen detection provides a credible rapid diagnostic test for pneumococcal pneumonia regardless of HIV-status. CRP response to acute infection is similar in HIV co-infection and increases diagnostic certainty.
authors: Division of Infectious Disease and International Medicine, Department of Medicine, University of Minnesota, MMC 250, 420 Delaware St. SE, Minneapolis, MN 55455, USA. boulw001@umn.edu
authors: David R
authors: DR
authors: Boulware
authors: Charles L
authors: CL
authors: Daley
authors: Cynthia
authors: C
authors: Merrifield
authors: Philip C
authors: PC
authors: Hopewell
authors: Edward N
authors: EN
authors: Janoff
mesh_terms: D000328:Adult; D000942:Antigens, Bacterial / Q000652:urine; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis* / Q000209:etiology / Q000652:urine; D011135:Polysaccharides, Bacterial / Q000652:urine*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016482:Urinalysis
chemical_list: D000942:Antigens, Bacterial; D011135:Polysaccharides, Bacterial; C027158:polysaccharide C-substance (Streptococcus); D002097:C-Reactive Protein
references: N Engl J Med. 1995 Sep 28;333(13):845-51
references: 7651475
references: Eur J Clin Microbiol Infect Dis. 2005 Mar;24(3):190-5
references: 15782278
references: Clin Chest Med. 2005 Mar;26(1):47-55
references: 15802165
references: BMJ. 2005 Feb 26;330(7489):456
references: 15684024
references: Nat Med. 2004 Aug;10(8):811-3
references: 15247911
references: Clin Infect Dis. 2004 Jul 15;39(2):165-9
references: 15307023
references: Clin Infect Dis. 1999 Apr;28(4):764-9
references: 10825036
references: Int J Infect Dis. 2006 Mar;10(2):124-8
references: 16290014
references: Lancet Infect Dis. 2004 Jul;4(7):445-55
references: 15219555
references: Infect Immun. 1993 Jul;61(7):3076-7
references: 8514415
references: Pathol Biol (Paris). 2004 Oct;52(8):429-33
references: 15465259
references: Rev Clin Esp. 2003 Nov;203(11):521-5
references: 14599391
references: Lancet. 1987 Mar 21;1(8534):671-4
references: 2882091
references: BMC Med Res Methodol. 2006 Jul 12;6:31
references: 16836745
references: Thorax. 2001 Dec;56 Suppl 4:IV1-64
references: 11713364
references: Eur Respir J. 2003 Feb;21(2):209-14
references: 12608431
references: Respir Med. 2006 May;100(5):884-91
references: 16226441
references: J Clin Microbiol. 2003 Jul;41(7):2810-3
references: 12843005
references: Clin Infect Dis. 2005 Jun 1;40(11):1608-16
references: 15889358
references: Eur J Clin Microbiol Infect Dis. 2001 Nov;20(11):840-1
references: 11783708
references: Kansenshogaku Zasshi. 2005 Jan;79(1):13-9
references: 15717478
references: Int J Infect Dis. 2007 May;11(3):284-5
references: 17236801
references: Kansenshogaku Zasshi. 2002 Dec;76(12):995-1002
references: 12607345
references: J Microbiol Immunol Infect. 2006 Feb;39(1):39-44
references: 16440122
references: Ann Intern Med. 2006 Jan 3;144(1):1-9
references: 16389249
references: Clin Infect Dis. 2001 Mar 1;32(5):824-5
references: 11229853
references: J Clin Epidemiol. 1993 Jun;46(6):497-507
references: 8501476
references: Clin Vaccine Immunol. 2006 Oct;13(10):1092-7
references: 17028212
references: Ann Intern Med. 1992 Aug 15;117(4):314-24
references: 1637028
references: J Clin Microbiol. 2001 Oct;39(10):3495-8
references: 11574562
references: Vital Health Stat 13. 2005 Mar;(158):1-199
references: 15853196
references: Thorax. 2001 Apr;56(4):296-301
references: 11254821
references: Nihon Kokyuki Gakkai Zasshi. 2004 Mar;42(3):247-52
references: 15069781
references: J Infect Dis. 2005 Jun 15;191(12):2038-45
references: 15897989
references: Clin Infect Dis. 2002 Apr 1;34(7):1025-8
references: 11880971
references: N Engl J Med. 2003 Oct 2;349(14):1341-8
references: 14523142
references: Chest. 2001 Jan;119(1):243-9
references: 11157611
references: Clin Infect Dis. 2004 Jul 15;39(2):170-2
references: 15307024
references: Clin Infect Dis. 2004 Jan 15;38(2):222-6
references: 14699454
references: Jpn J Infect Dis. 2006 Dec;59(6):388-90
references: 17186959
references: Lancet. 1998 Oct 17;352(9136):1295-302
references: 9788476
references: Intensive Care Med. 2006 Nov;32(11):1766-72
references: 16957905
references: J Clin Microbiol. 2004 Aug;42(8):3620-5
references: 15297507
references: Clin Infect Dis. 2006 Jul 1;43(1):90-8
references: 16758423
references: Rinsho Biseibutshu Jinsoku Shindan Kenkyukai Shi. 2005;16(2):153-61
references: 16536061
references: Clin Infect Dis. 1999 Sep;29(3):536-43
references: 10530443
references: Am J Respir Crit Care Med. 1995 Dec;152(6 Pt 1):2000-4
references: 8520768
references: Clin Infect Dis. 2003 Feb 1;36(3):286-92
references: 12539069
references: J Infect Chemother. 2004 Dec;10(6):359-63
references: 15614462
references: N Engl J Med. 1995 Dec 14;333(24):1618-24
references: 7477199
references: New Microbiol. 2002 Apr;25(2):259-63
references: 12019736
references: Lancet. 2000 Jun 17;355(9221):2106-11
references: 10902624
references: Thorax. 2000 Dec;55(12):1040-5
references: 11083890
references: Clin Infect Dis. 2006 Apr 15;42(8):1135-40
references: 16575731
references: Ann Intern Med. 2000 Feb 1;132(3):182-90
references: 10651598
references: J Infect Dis. 2001 Jan 15;183(2):239-246
references: 11120930