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Pneumococcal urinary antigen positivity in healthy colonized children: is it age dependent?

Die Pneumokokken-Antigen-Positivität im Urintesten bei gesunden kolonisierten Kindern – ist diese vom Alter abhängig?

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Abstract

Background

Pneumococcal urinary antigen test is a valuable tool for diagnosing pneumococcal pneumonia and meningitis in adults. Its use in children is generally not accepted because of nonspecificity at this age. It is frequently positive in asymptomatic nasopharyngeal carriers.

The aim of our study was to assess the age limit from which the test is no longer positive in asymptomatic healthy carriers.

Methods

A total of 197 children aged 36–83 months attending 9 day care centers in Prague were enrolled during February and March 2010. Nasopharyngeal swab specimens were collected from each participant and selectively cultivated. The presence of pneumococcal antigen in urine was detected by BinaxNOW® S. pneumoniae kit.

Results

Streptococcus pneumoniae was cultivated in 53.3 % of healthy children with the highest colonization rate (59.3 %) in children aged 48–59 months. The most frequently colonizing serotypes were: 19F, 23F, 3, 19A, 6B and 4. The presence of pneumococcal antigen in urine decreased with age from 39.0 % in 36–47 months to 17.9 % in 72–83 months old (p = 0.031). The antigen positivity was serotype-dependent and more frequent in nonvaccinated children.

Conclusion

We demonstrated age-dependent linear decrease of pneumococcal antigen excretion into urine in healthy children. The positivity rate of the test in children aged 72–83 months was similar to that referred in healthy adults, irrespective of colonization. To confirm this age limit for use of this test in diagnostics of pneumococcal diseases, further study in school-age children is justified.

Zusammenfassung

Grundlagen

Ein Pneumokokken-Antigen-Urintest ist eine wertvolle Methode für die Diagnostik einer Pneumonie und Meningitis bei Erwachsenen. Die Anwendung der Methode bei Kindern ist üblicherweise nicht akzeptierbar, weil diese im Kinderalter für nicht-spezifisch gehalten wird. Der Test ist oft bei asymptomatischen nasopharyngealen Trägern positiv. Das Ziel unserer Studie war, die Altersgrenze, ab wann der Test in asymptomatischen gesunden Träger negativ ist, festzustellen.

Methodik

Insgesamt 197 Kinder im Alter von 36–83 Monaten, die 9 Tages-Betreuungszentren in Prag besuchten, wurden in Februar und März 2010 in die Studie eingeschlossen. Nasopharyngeale Abstriche wurden von jedem Teilnehmer abgenommen und selektiv kultiviert. Für die Entdeckung von Pneumokokken-Antigen im Urin wurde BinaxNOW® S. pneumoniae verwendet.

Ergebnisse

S. pneumoniae war bei 53,3 % gesunden Kindern kultiviert, die höchste Kolonisationsrate gab es bei Kindern im Alter von 48–59 Monaten. Die am häufigsten kolonisierten Serotypen waren: 19F, 23F, 3, 19A, 6B und 4. Das Vorkommen von einem Pneumokokken-Antigen im Urin sank mit Alter – von 39,0 % in 36–47 Monaten zu 17,9 % in 72–83 Monaten (p = 0,031). Die Antigen-Positivität war vom Serotyp abhängig und fand öfter bei nicht-vakzinierten Kindern statt.

Schlussfolgerung

Wir haben einen altersabhängigen linearen Abfall der Exkretion von Pneumokokken-Antigen in Urin bei gesunden Kindern bestätigt. Die Positivitätsrate des Testes bei Kindern, die 72–83 Monate alt sind, ist der Rate von gesunden Erwachsenen, ohne Zusammenhang mit der Kolonisation, ähnlich. Zur Bestätigung einer Altersgrenze für die Verwendung von diesem Test in der Diagnostik der pneumokokkalen Erkrankungen ist eine weitere Studie mit Kindern im Schulalter nötig.

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Conflict of interest

This study was kindly supported by Medial Ltd. by providing the kits for detection of pneumococcal antigen in urine. The authors did not receive any funding or financial assistance from the aforementioned company, neither was the sponsor involved in the design of the study, collection, analysis, interpretation of data, as well as in compilation or in decision to submit the manuscript. The study was partially supported by research grant A/CZ0046/2/0007 from Iceland, Liechtenstein and Norway via the EEA financial mechanism and by research grant IGA 9643–4 from the Internal Grant Agency, Czech Ministry of Health.

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Authors and Affiliations

  1. Department of Paediatrics, Hořovice Hospital, NH Hospital, Hořovice, Czech Republic

    Zuzana Vančíková MD, PhD

  2. 1st Department of Infectious Diseases, 2nd Medical Faculty and Hospital Na Bulovce, Charles University in Prague, Budinova 2, 180 81, Prague, Czech Republic

    Milan Trojánek MD, Zuzana Blechová MD, Jerry John MD &  Vilma Marešová MD, PhD

  3. National Reference Laboratory for Antibiotics, National Institute of Public Health, Prague, Czech Republic

    Helena Žemličková MD, PhD

  4. National Reference Laboratory for Streptococci and Enterococci, National Institute of Public Health, Prague, Czech Republic

    Jitka Motlová

  5. Institute of Medical Microbiology, 2nd Medical Faculty and Motol University Hospital, Charles University in Prague, Prague, Czech Republic

    Jana Matějková MD & Otakar Nyč MD, PhD

  6. Centre for Biostatistics, National Institute of Public Health, Prague, Czech Republic

    Marek Malý

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  1. Zuzana Vančíková MD, PhD
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Correspondence to Milan Trojánek MD.

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Vančíková, Z., Trojánek, M., Žemličková, H. et al. Pneumococcal urinary antigen positivity in healthy colonized children: is it age dependent?. Wien Klin Wochenschr 125, 495–500 (2013). https://doi.org/10.1007/s00508-013-0405-4

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