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Clinical Trial
. 2007 Oct;55(4):300-9.
doi: 10.1016/j.jinf.2007.06.014. Epub 2007 Aug 10.

Rapid diagnosis of pneumococcal pneumonia among HIV-infected adults with urine antigen detection

David R Boulware  1 , Charles L Daley, Cynthia Merrifield, Philip C Hopewell, Edward N Janoff
Affiliations
Clinical Trial

Rapid diagnosis of pneumococcal pneumonia among HIV-infected adults with urine antigen detection

David R Boulware et al. J Infect. 2007 Oct.

Abstract

Objectives: 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.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Distribution of the microbiologic determination of pneumococcal pneumonia
Figure 2
Figure 2
CRP Response among patients with pneumococcal pneumonia by HIV-status
Figure 3
Figure 3
Forest plot of the sensitivity and specificity of Binax urine antigen ICT performance.
See this image and copyright information in PMC

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