Time Trend of the Sensitivity of the Pneumococcal Urinary Antigen Test for Diagnosing Pneumococcal Community-Acquired Pneumonia: An Analysis of 15-Year, Prospective Cohort Data

Legionnaires' disease is an uncommon but important cause of life-threatening community-acquired or nosocomial pneumonia. The urinary antigen enzyme immunoassay test, used in Victoria since 1995, now accounts for the majority of initial laboratory notifications (81% in 1999). We review the impact of the test on the disease epidemiology and the public health investigative process. We focus on the major subgroup of cases due to Legionella pneumophila serogroup 1, comparing delays until notification and mortality for urinary antigen detected cases with culture detected cases. The urinary antigen test facilitates a 5-day reduction for the delay between onset of illness and notification. We observed that there was minimal clinical heterogeneity of urinary antigen detected cases whether they were subsequently culture confirmed or not. We encourage clinician use of the urinary antigen test in cases of community-acquired pneumonia where Legionnaires' disease is a possible diagnosis, in conjunction with culture of clinical specimens.

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Identified micro-organisms in hospitalized community-acquired pneumonia patients living near goat and poultry farms

Pneumonia ◽

10.1186/s41479-021-00091-w ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Inge Roof ◽

Arianne B. van Gageldonk-Lafeber ◽

Tizza P. Zomer ◽

Yolande M. Vermeeren ◽

Peter C. Wever ◽

...

Keyword(s):

The Netherlands ◽

Community Acquired Pneumonia ◽

Test Results ◽

Antigen Test ◽

Urinary Antigen ◽

Urinary Antigen Test ◽

Home Address ◽

Laboratory Test Results ◽

Poultry Farms ◽

Micro Organisms

Abstract Background In the Netherlands, an increased risk of community-acquired pneumonia (CAP) has been reported for adults living near goat and poultry farms. Previous results of respiratory microbiome studies in hospitalized CAP patients near poultry farms suggested a higher relative abundance of Streptococcus pneumoniae. This retrospective study, using routine laboratory data from hospitalized CAP patients, aims to explore possible aetiologic micro-organisms of CAP in relation to livestock exposure. Methods Patient characteristics and PCR and urinary antigen test results were retrieved retrospectively from electronic medical records of CAP patients admitted to the Jeroen Bosch Hospital or Gelre Hospital in the Netherlands during 2016–2017. Distances between the patients’ home address and the nearest poultry and goat farm were calculated. Differences in laboratory test results between CAP patients with and without goat or poultry farms within 2 km of their home address were analyzed using Fisher’s exact test. Results In total, 2230 CAP episodes with diagnostic results were included. In only 25% of the CAP episodes, a micro-organism was detected. A positive urinary antigen test for S. pneumoniae was found more often in patients living within two kilometers of goat (15.2% vs. 11.3%) and poultry farms (14.4% vs. 11.3%), however these differences were not statistically significant (p = 0.1047 and p = 0.1376). Conclusion Our retrospective analysis did not show statistically significant differences in the identified micro-organisms in hospitalized CAP patients related to livestock farming. The study was hampered by limited statistical power and limited laboratory results. Therefore, the potential increased CAP risk around goat and poultry farms will be further explored in a prospective study among CAP patients in primary care.

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