title: Multiplex Urinary Antigen Detection for 13 Streptococcus pneumoniae Serotypes Improves Diagnosis of Pneumococcal Pneumonia in South African HIV-Infected Adults.
abstract: A serotype-specific urinary antigen detection (UAD) assay for 13 serotypes included in the pneumococcal conjugate vaccine (PCV13) was recently reported as a useful diagnostic tool for pneumococcal pneumonia. We aimed to assess the diagnostic accuracy of the UAD in HIV-infected South African adults. Urine specimens from a well-defined cohort of HIV-infected South African adults with pneumonia were evaluated retrospectively in the UAD assay. Pneumonia was considered pneumococcal if either sputum Gram stain, sputum culture, blood culture, or the immunochromatographic (ICT) BinaxNow S. pneumoniae test (composite diagnostic) was positive. Among 235 enrolled pneumonia patients, the UAD assay was more frequently positive (104 [44.3%]) than the composite diagnostic (71 [30.2%]; P < 0.001) and increased the pneumococcal etiology from 30.2% by an additional 22.6% to 52.8%. The UAD assay detected more pneumococcal etiologies (45.0%) than the serotype-independent ICT (23.4%, P < 0.001). UAD identified 6/7 patients with PCV13 serotype bacteremia without misclassification of bacteremia episodes due to non-PCV13 serotypes. UAD was positive for 5.1% of asymptomatic HIV-infected persons, with higher rates among those with nasopharyngeal carriage. Concordance between serotypes identified by UAD and by Quellung reaction and PCR serotyping was 70/86 (81.4%). UAD identified the dominant serotype in multiple serotype carriage. This study confirms the utility of the UAD assay for HIV-infected adults comparing favorably with other diagnostic tests. A highly valent UAD may become a new standard for detection of pneumococcal pneumonia in adults. Prior to PCV introduction, at least 53% of pneumonia cases were due to pneumococci in HIV-infected South African adults.
authors.affiliation: Respiratory and Meningeal Pathogens Research Unit/Medical Research Council, Johannesburg, South Africa Werner.albrich@kssg.ch.|Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Werner C
authors.initials: WC
authors.lastname: Albrich
authors.affiliation: Pfizer Vaccine Research and Development, Pfizer Inc., Pearl River, New York, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Pride
authors.affiliation: Respiratory and Meningeal Pathogens Research Unit/Medical Research Council, Johannesburg, South Africa.|National Institute for Communicable Diseases, Johannesburg, South Africa.
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Madhi
authors.affiliation: Callahan Associates Inc., La Jolla, California, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Callahan
authors.affiliation: Respiratory and Meningeal Pathogens Research Unit/Medical Research Council, Johannesburg, South Africa.|National Institute for Communicable Diseases, Johannesburg, South Africa.
authors.forename: Peter V
authors.initials: PV
authors.lastname: Adrian
authors.affiliation: Biotechnology Clinical Development Statistics, Pfizer Inc., Pearl River, New York, USA.
authors.forename: Roger
authors.initials: R
authors.lastname: French
authors.affiliation: Respiratory and Meningeal Pathogens Research Unit/Medical Research Council, Johannesburg, South Africa.
authors.forename: Nadia
authors.initials: N
authors.lastname: van Niekerk
authors.affiliation: Pfizer Vaccine Research and Development, Pfizer Inc., Pearl River, New York, USA.
authors.forename: Shite
authors.initials: S
authors.lastname: Sebastian
authors.affiliation: Pfizer Vaccine Research and Development, Pfizer Inc., Pearl River, New York, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Souza
authors.affiliation: Emerging Pathogens Laboratory, Fondation Mérieux, Lyon, France.
authors.forename: Jean-Noel
authors.initials: JN
authors.lastname: Telles
authors.affiliation: Emerging Pathogens Laboratory, Fondation Mérieux, Lyon, France.
authors.forename: Glaucia
authors.initials: G
authors.lastname: Paranhos-Baccalà
authors.affiliation: Pfizer Vaccine Research and Development, Pfizer Inc., Pearl River, New York, USA.
authors.forename: Kathrin U
authors.initials: KU
authors.lastname: Jansen
authors.affiliation: Respiratory and Meningeal Pathogens Research Unit/Medical Research Council, Johannesburg, South Africa.|National Institute for Communicable Diseases, Johannesburg, South Africa.|Hubert Department of Global Health and Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA.
authors.forename: Keith P
authors.initials: KP
authors.lastname: Klugman
mesh_terms: D000328:Adult; D000942:Antigens, Bacterial / Q000652:urine*; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007118:Immunoassay / Q000379:methods*; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis*; D012189:Retrospective Studies; D065288:Serogroup; D013019:South Africa; D013296:Streptococcus pneumoniae / Q000276:immunology*
chemical_list: D000942:Antigens, Bacterial
keywords: diagnosis; human immunodeficiency virus; pneumococcal pneumonia; serotyping; urinary antigen