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Comparative Study
. 2009 Mar 1;48 Suppl 2(Suppl 2):S49-56.
doi: 10.1086/596481.

Enhanced diagnosis of pneumococcal meningitis with use of the Binax NOW immunochromatographic test of Streptococcus pneumoniae antigen: a multisite study

Jennifer C Moïsi  1 , Samir K Saha, Adegoke G Falade, Berthe-Marie Njanpop-Lafourcade, Joseph Oundo, Anita K M Zaidi, Shirin Afroj, R A Bakare, Julie K Buss, Razzaq Lasi, Judith Mueller, A A Odekanmi, Lassana Sangaré, J Anthony G Scott, Maria Deloria Knoll, Orin S Levine, Bradford D Gessner
Affiliations
Comparative Study

Enhanced diagnosis of pneumococcal meningitis with use of the Binax NOW immunochromatographic test of Streptococcus pneumoniae antigen: a multisite study

Jennifer C Moïsi et al. Clin Infect Dis. .

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.

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Figures

Figure 1
Figure 1
Distribution of cerebrospinal fluid white blood cell count, by site, among persons of all ages presenting with suspected acute bacterial meningitis.
Figure 2
Figure 2
Proportion of cerebrospinal fluid specimens positive for Streptococcus pneumoniae by culture, latex agglutination or the Binax NOW® S. pneumoniae ICT, among children <5 years old
See this image and copyright information in PMC

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