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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e31828c363f
Original Studies

Evaluation of a WHO-validated Serotype-specific Serological Assay for the Diagnosis of Pneumococcal Etiology in Children With Community-acquired Pneumonia

Tuerlinckx, David MD*; Smet, Julie MD†‡; De Schutter, Iris MD, PhD§; Jamart, Jacques MD, MSc; Vergison, Anne MD, PhD; Raes, Marc MD**; Smeesters, Pierre R. MD, PhD††; Verhaegen, Jan MD, PhD‡‡; Surmont, Filip MD§§; Malfroot, Anne MD, PhD§; Mascart, Françoise MD, PhD†‡

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Background: The etiologic diagnosis of community-acquired pneumonia (CAP) remains challenging in children because blood cultures have low sensitivity. Novel approaches are needed to confirm the role of Streptococcus pneumoniae.

Methods: In this study, pneumococcal etiology was determined by serology using a subset of blood samples collected during a prospective multicentre observational study of children <15 years of age hospitalized in Belgium with radiogram-confirmed CAP. Blood samples were collected at admission and 3–4 weeks later. Pneumococcal (P)-CAP was defined in the presence of a positive blood or pleural fluid culture. Serotyping of S. pneumoniae isolates was done with the Quellung reaction. Serological diagnosis was assessed for 9 serotypes using World Health Organization–validated IgG and IgA serotype-specific enzyme-linked immunosorbent assays (ELISAs).

Results: Paired admission/convalescent sera from 163 children were evaluated by ELISA (35 with proven P-CAP and 128 with nonproven P-CAP). ELISA detected pneumococci in 82.8% of patients with proven P-CAP. The serotypes identified were the same as with the Quellung reaction in 82% and 59% of cases by IgG ELISA and IgA ELISA, respectively. Overall, ELISA identified a pneumococcal etiology in 55% of patients with nonproven P-CAP. Serotypes 1 (51.6%), 7F (19%) and 5 (15.7%) were the most frequent according to IgG ELISA.

Conclusions: In conclusion, the serological assay allows recognition of pneumococcal origin in 55% of CAP patients with negative culture. This assay should improve the diagnosis of P-CAP in children and could be a useful tool for future epidemiological studies on childhood CAP etiology.

© 2013 by Lippincott Williams & Wilkins, Inc.


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