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This Article Full Text (PDF) Free All Versions of this Article: chest.06-1884v1 131/5/1442    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Porcel, J. M. Articles by Esquerda, A. Search for Related Content PubMed PubMed Citation Articles by Porcel, J. M. Articles by Esquerda, A.

CONTRIBUTION OF A PLEURAL ANTIGEN ASSAY (BINAX NOW) TO THE DIAGNOSIS OF PNEUMOCOCCAL PNEUMONIA

From the Pleural Diseases Unit, Departments of Internal Medicine (Drs. Ruiz, Falguera, Galindo, and Porcel), Clinical Microbiology (Dr. Nogués), and Laboratory Medicine (Dr. Esquerda), Arnau de Vilanova University Hospital, IRBLLEIDA, Lleida, Spain; and Infectious Disease Service (Dr. Carratalá), Hospital Universitari de Bellvitge, Barcelona

jporcelp{at}yahoo.es

Abstract

Study objectivesTo determine whether detection of pneumococcal antigen in pleural fluid augments conventional microbiological methods used for the etiological diagnosis of pneumonia.

MethodsIn this retrospective study, a rapid immunochromatographic (ICT) test (Binax NOW Streptococcus pneumoniae) was performed on pleural fluid samples from 34 patients with pneumonia due to S. pneumoniae, 89 patients with effusions of non-pneumococcal origin, and 17 patients with pneumonia of unknown etiology. Data on blood cultures, pleural fluid cultures and urinary antigen tests were recorded.

ResultsThe ICT test was positive in 24 (70.6%) of 34 patients with pneumococcal pneumonia and negative in 83 (93.3%) of 89 patients without pneumococcal pneumonia. The sensitivity of the pleural ICT test was higher than that obtained for blood (37.5%) and pleural fluid cultures (32.3%), but lower than detection of pneumococcal antigen in urine (82.1%). However, 3 patients with pneumococcal pneumonia and a negative ICT urine test had a positive pleural fluid antigen detection test. Previous antibiotic exposure did not influence pneumococcal antigen detection in either pleural fluid or urine specimens. Six additional patients with empyema due to anaerobes (3), Streptococcus viridans (2), and Enterococcus faecalis (1) had false positive pleural ICT tests. Finally, the ICT assay was also positive in 5 of 17 (29.4%) patients with pneumonia without a definite microbiological cause.

ConclusionsICT test performed on pleural fluid samples augments standard diagnostic methods of blood and pleural fluid cultures, even in the case of prior antibiotics, and enhances the ICT urinary antigen assay.

Key Words: pleural effusion • pneumococcal pneumonia • empyema • immunochromatographic test