title: Enhanced diagnosis of pneumococcal meningitis with use of the Binax NOW immunochromatographic test of Streptococcus pneumoniae antigen: a multisite study.
abstract: BACKGROUND
  Accurate etiological diagnosis of meningitis in developing countries is needed, to improve clinical care and to optimize disease-prevention strategies. Cerebrospinal fluid (CSF) culture and latex agglutination testing are currently the standard diagnostic methods but lack sensitivity.
  
  
  METHODS
  We prospectively assessed the utility of an immunochromatographic test (ICT) of pneumococcal antigen (NOW Streptococcus pneumoniae Antigen Test; Binax), compared with culture, in 5 countries that are conducting bacterial meningitis surveillance in Africa and Asia. Most CSF samples were collected from patients aged 1-59 months.
  
  
  RESULTS
  A total of 1173 CSF samples from suspected meningitis cases were included. The ICT results were positive for 68 (99%) of the 69 culture-confirmed pneumococcal meningitis cases and negative for 124 (99%) of 125 culture-confirmed bacterial meningitis cases caused by other pathogens. By use of culture and latex agglutination testing alone, pneumococci were detected in samples from 7.4% of patients in Asia and 15.6% in Africa. The ICT increased pneumococcal detection, resulting in similar identification rates across sites, ranging from 16.2% in Nigeria to 20% in Bangladesh. ICT detection in specimens from culture-negative cases varied according to region (8.5% in Africa vs. 18.8% in Asia; P< .001), prior antibiotic use (24.2% with prior antibiotic use vs. 12.2% without; P< .001), and WBC count (9.0% for WBC count of 10-99 cells/mL, 22.1% for 100-999 cells/mL, and 25.4% for >or=1000 cells/mL; P< .001 by test for trend).
  
  
  CONCLUSIONS
  The ICT provided substantial benefit over the latex agglutination test and culture at Asian sites but not at African sites. With the addition of the ICT, the proportion of meningitis cases attributable to pneumococci was determined to be similar in Asia and Africa. These results suggest that previous studies have underestimated the proportion of pediatric bacterial meningitis cases caused by pneumococci.
authors.affiliation: GAVI Alliance's PneumoADIP, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA. jmoisi@jhsph.edu
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Moïsi
authors.forename: Samir K
authors.initials: SK
authors.lastname: Saha
authors.forename: Adegoke G
authors.initials: AG
authors.lastname: Falade
authors.forename: Berthe-Marie
authors.initials: BM
authors.lastname: Njanpop-Lafourcade
authors.forename: Joseph
authors.initials: J
authors.lastname: Oundo
authors.forename: Anita K M
authors.initials: AK
authors.lastname: Zaidi
authors.forename: Shirin
authors.initials: S
authors.lastname: Afroj
authors.forename: R A
authors.initials: RA
authors.lastname: Bakare
authors.forename: Julie K
authors.initials: JK
authors.lastname: Buss
authors.forename: Razzaq
authors.initials: R
authors.lastname: Lasi
authors.forename: Judith
authors.initials: J
authors.lastname: Mueller
authors.forename: A A
authors.initials: AA
authors.lastname: Odekanmi
authors.forename: Lassana
authors.initials: L
authors.lastname: Sangaré
authors.forename: J Anthony G
authors.initials: JA
authors.lastname: Scott
authors.forename: Maria Deloria
authors.initials: MD
authors.lastname: Knoll
authors.forename: Orin S
authors.initials: OS
authors.lastname: Levine
authors.forename: Bradford D
authors.initials: BD
authors.lastname: Gessner
mesh_terms: D000349:Africa; D000942:Antigens, Bacterial / Q000302:isolation & purification*; D001208:Asia; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002675:Child, Preschool; D002846:Chromatography, Affinity / Q000379:methods*; D006801:Humans; D007223:Infant; D008586:Meningitis, Pneumococcal / Q000175:diagnosis*; D011446:Prospective Studies; D011933:Reagent Kits, Diagnostic; D012680:Sensitivity and Specificity; D013296:Streptococcus pneumoniae / Q000737:chemistry / Q000302:isolation & purification*
chemical_list: D000942:Antigens, Bacterial; D011933:Reagent Kits, Diagnostic