Abstract
In a prospective study of 249 patients with community-acquired pneumonia, three tests for the detection of pneumococcal antigen in sputum were compared: a coagglutination test for detecting capsular antigens (Cap-CoA), a sandwich enzyme immunoassay (PnC-EIA) and a coagglutination test (PnC-CoA), both the latter detecting the pneumococcal C-polysaccharide common to all pneumococcal types. Sixty-three patients had culture-positive pneumococcal pneumonia, 45 pneumonia caused by other bacteria and 141 pneumonia of viral or unknown etiology. The sensitivity of Cap-CoA (63%) and PnC-CoA (65%) was somewhat higher than that of PnC-EIA (49%), but not significantly so. The specificity was 96–98% for all three methods. Using PnC-CoA 66 patients with possible pneumococcal infection were detected, the diagnosis being verified by culture in 41. Using Cap-CoA 59 such patients were detected, the diagnosis being verified in 40, and using the PnC-EIA 47 such patients were detected, the diagnosis being verified in 31. Antigen was found almost as often in non-purulent as in purulent samples, and as often in washed as in non-washed purulent samples. However, antibiotic treatment before the sputum sample was obtained resulted in significantly lower sensitivity of both PnC-CoA and Cap-CoA. This study confirms the high sensitivity and specificity of methods for pneumococcal antigen detection in sputum. Since CoA is easier and quicker to perform, and cheaper than the EIA, either PnC-CoA or Cap-CoA would seem to be the technique of choice for detection of pneumococcal antigen, whereby all sputum samples, including non-purulent samples, can be used.
Similar content being viewed by others
References
Macfarlane, J. T., Ward, M. J., Finch, R. G., Macrae, D. Hospital study of adult community-acquired pneumonia. Lancet 1982, ii: 255–258.
Kerttula, Y., Leinonen, M., Koskela, M., Mäkelä, P. H. The aetiology of pneumonia. Application of bacterial serology and basic laboratory methods. Journal of Infection 1987, 14: 21–30.
Holmberg, H. Aetiology of community-acquired pneumonia in hospital treated patients. Scandinavian Journal of Infectious Diseases 1987, 19: 491–501.
Örtqvist, Å., Grepe, A., Julander, I., Kalin, M. Bacteremic pneumococcal pneumonia in Sweden; clinical course and outcome and comparison with non-bacteremic pneumococcal and mycoplasmal pneumonias. Scandinavian Journal of Infectious Diseases 1988, 20: 163–171.
Lehtomäki, K. Rapid etiological diagnosis of pneumonia in young men. Scandinavian Journal of Infectious Diseases 1988, 20, Supplement 54: 1–56.
Kalin, M., Lindberg, A. A., Olausson, E.-H. Diagnosis of pneumococcal pneumonia by coagglutination and counterimmunoelectrophoresis of sputum samples. European Journal of Clinical Microbiology 1982, 1: 91–96.
Lund, E., Henrichsen, J. Laboratory diagnosis, serology and epidemiology ofStreptococcus pneumoniae. In: Bergan, T., Norris, J. R. (ed.): Methods in microbiology. Academic Press, New York, 1978, p. 241–262.
Holmberg, H., Holme, T., Krook, A., Olsson, T., Sjöberg, L., Sjögren, A. M. Detection of C polysaccharide inStreptococcus pneumoniae in the sputa of pneumonia patients by an enzyme-linked immunosorbent assay. Journal of Clinical Microbiology 1985, 22: 111–115.
Krook, A., Holmberg, H., Sjögren, A. M. A new coagglutination test for detecting pneumococcal C polysaccharide. European Journal of Clinical Microbiology 1987, 6: 68–69.
Dorff, G. J., Coonrod, J. D., Rytel, M. V. Detection by immunoelectrophoresis of antigen in sera of patients with pneumococcal bacteremia. Lancet 1971, i: 578–579.
Edwards, E. A., Coonrod, J. D. coagglutination and counterimmunoelectrophoresis for detection pf pneumococcal antigens in the sputum of pneumonia patients. Journal of Clinical Microbiology 1980, 11: 488–491.
Holmberg, H., Krook, A. Comparison of enzyme-linked immunosorbent assay with coagglutination and latex agglutination for rapid diagnosis of pneumococcal penumonia by detecting antigen in sputa. European Journal of Clinical Microbiology 1986, 5: 282–286.
Krook, A., Holmberg, H. Pneumococcal antigens in sputa: ELISA for the detection of pneumococcal C polysaccharide in sputa from pneumonia patients. Diagnostic Microbiology and Infectious Disease 1987, 7: 73–75.
Lenthe-Eboa, S., Brighouse, G., Auckenthaler, R., Lew, D., Zwahlen, A., Lambert, P.-H., Waldvogel, F. A. Comparison of immunological methods for diagnosis of penumococcal pneumonia in biological fluids. European Journal of Clinical Microbiology 1987, 6: 28–34.
Kalin, M., Lindberg, A. A. Diagnosis of pneumococcal pneumonia: a comparison between microscopic examination of expectorate, antigen detection and cultural procedures. Scandinavian Journal of Infectious Diseases 1983, 15: 247–255.
Kalin, M., Lindberg, A. A., Tunevall, G. Etiological diagnosis of bacterial pneumonia by Gram stain and quantitative culture of expectorates. Scandinavian Journal of Infectious Diseases 1983, 15: 153–160.
Bartlett, J. G., Finegold, S. M. Bacteriology of expectorated sputum with quantitative culture and wash technique compared to transtracheal aspirates. American Review of Respiratory Diseases 1978, 117: 1019–1027.
Kalin, M. Bacteremic pneumococcal pneumonia: value of culture of nasopharyngeal specimens and examination of washed sputum specimens. European Journal of Clinical Microbiology 1982, 1: 394–396.
Sjögren, A. M., Holmberg, H., Krook, A. Etiologic diagnosis of pneumonia by antigen detection: cross-reactions between pneumococcal C polysaccharide and oral microorganisms. Diagnostic Microbiology and Infectious Disease 1987, 6: 239–248.
Holmberg, H., Danielsson, D., Hardie, J., Krook, A., Whiley, R. Cross-reactions between α-streptococci and omniserum, an polyvalent pneumococcal serum, demonstrated by direct immunofluorescence, immunoelectroosmophoresis, and latex agglutination. Journal of Clinical Microbiology 1985, 21: 745–748.
Krook, A., Fredlund, H., Holmberg, H. Diagnosis of pneumococcal pneumonia by detection of antigen in saliva. European Journal of Clinical Microbiology 1986, 5: 639–642.
Telenti, A., Leiva, P. S. Persistence of pneumococcal antigens in sputum after treatment of pneumonia. Scandinavian Journal of Infectious Diseases 1984, 16: 323–324.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Örtqvist, A., Jönsson, I., Kalin, M. et al. Comparison of three methods for detection of pneumococcal antigen in sputum of patients with community-acquired pneumonia. Eur. J. Clin. Microbiol. Infect. Dis. 8, 956–961 (1989). https://doi.org/10.1007/BF01967565
Issue Date:
DOI: https://doi.org/10.1007/BF01967565