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Rapid Streptococcus Pneumonia Antigen Detection on Postmortem Urine in a Death Due to Pneumococcal Meningitis

Hensby-Bennett, Sarah MBChB, BSc(Hons)*; Garland, Jack BMed; Philcox, Winston BHSc; McCarthy, Sinead MBChB, DTM&H§; Playle, Veronica MBChB; Kesha, Kilak MD§; Stables, Simon MBChB, MNZM, DAvMed, AsFACAsM, FNZSP, FRCPA§; Tse, Rexson MB, BSc, BSFRCPA§

The American Journal of Forensic Medicine and Pathology: January 17, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PAF.0000000000000462
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Streptococcus pneumoniae is the leading cause of adult bacterial meningitis. Differing from Neisseria meningitidis (the second most common cause of acute bacterial meningitis), contact tracing and chemoprophylaxis are not required. At postmortem, the differentiation between S. pneumoniae and N. meningitidis is traditionally done by culture and polymerase chain reaction performed on blood or cerebrospinal fluid, but may take hours, if not days, to analyze. We present a death from bacterial meningitis in a 73-year-old woman in which a rapid urinary pneumococcal antigen testing was able to identify S. pneumoniae as the causative organism within 1 hour. This was confirmed by subsequent brain swab culture. The rapid urinary pneumococcal antigen test in the case prevented the need for contact tracing and chemoprophylaxis. This case highlights the potential use of this test to rapidly identify the culprit organism at postmortem examination when acute bacterial meningitis is detected.

From the *Waikato District Health Board, Waikato, New Zealand;

Hornsby Ku-Ring-Gai Hospital, Hornsby, New South Wales, Australia; and

Faculty of Medical and Health Sciences, University of Auckland; and

Departments of §Forensic Pathology and

Microbiology, LabPLUS, Auckland City Hospital, Auckland, New Zealand.

Manuscript received October 30, 2018; accepted November 29, 2018.

The authors report no conflict of interest.

Reprints: Rexson Tse, MB, BSc, BSFRCPA, Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland 1148, New Zealand. E-mail: rexson.tse@gmail.com; rexsont@adhb.govt.nz.

© 2019 by Lippincott Williams & Wilkins.