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

ABSTRACTAntigen detection has been reported to be a promising method for rapid diagnosis of coccidioidomycosis in humans.Coccidioidesantigen detection has not been previously reported in dogs with coccidioidomycosis and was evaluated in 60 cases diagnosed based on detection of anti-Coccidioidesantibodies at titers of 1:16 or more in serum. Controls included dogs with presumed histoplasmosis or blastomycosis, other fungal infections, or nonfungal diseases and healthy dogs. Urine and serum specimens were tested using an enzyme immunoassay forCoccidioidesgalactomannan antigen. Antibody testing was performed at commercial veterinary reference laboratories. Antigen was detected in urine or serum of 12 of 60 (20.0%), urine only in 2 of 57 (3.5%), and serum only in 11 of 58 (19.0%) dogs with coccidioidomycosis. Antigen was detected in the urine of 3 of 43 (7.0%) and serum of 1 of 37 (2.7%) dogs with histoplasmosis or blastomycosis but not in 13 dogs with other fungal infections (serum, 9; urine, 13), 41 dogs with nonfungal diseases (urine, 41; serum, 18), or healthy dogs (serum, 21; urine, 21). Detection of antigen was an insensitive method for diagnosis of coccidioidomycosis in dogs in which the diagnosis was based primarily upon detection of antibodies at titers of 1:16 or higher, and the highest sensitivity was in serum.

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Histoplasmosis, An Underdiagnosed Disease Affecting People Living With HIV/AIDS in Brazil: Results of a Multicenter Prospective Cohort Study Using Both Classical Mycology Tests and Histoplasma Urine Antigen Detection

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz073 ◽

2019 ◽

Vol 6 (4) ◽

Cited By ~ 7

Author(s):

Diego R Falci ◽

Alexandre A Monteiro ◽

Cassia Ferreira Braz Caurio ◽

Tulio C O Magalhães ◽

Melissa O Xavier ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Antigen Detection ◽

People Living With Hiv ◽

Urine Antigen ◽

Multicenter Prospective Cohort Study ◽

Living With Hiv ◽

Multicenter Prospective Cohort ◽

Hiv Aids

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Multiplex Urinary Antigen Detection for 13 Streptococcus pneumoniae Serotypes Improves Diagnosis of Pneumococcal Pneumonia in South African HIV-Infected Adults

Journal of Clinical Microbiology ◽

10.1128/jcm.01573-16 ◽

2016 ◽

Vol 55 (1) ◽

pp. 302-312 ◽

Cited By ~ 3

Author(s):

Werner C. Albrich ◽

Michael W. Pride ◽

Shabir A. Madhi ◽

Jan Callahan ◽

Peter V. Adrian ◽

...

Keyword(s):

South African ◽

Pneumococcal Pneumonia ◽

Antigen Detection ◽

Urinary Antigen ◽

Content Type ◽

Urinary Antigen Detection ◽

Dominant Serotype ◽

Quellung Reaction ◽

Urine Specimens ◽

Asymptomatic Hiv

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.

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