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Journal of Clinical Microbiology, March 1999, p. 633-637, Vol. 37, No. 3
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

Pneumolysin PCR-Based Diagnosis of Invasive Pneumococcal Infection in Children

Pia Toikka,1,2,* Simo Nikkari,2,3,dagger Olli Ruuskanen,1 Maija Leinonen,4 and Jussi Mertsola1,5

Department of Pediatrics1 and Department of Clinical Microbiology,3 Turku University Hospital, and Department of Medical Microbiology, Turku University,2 Turku, National Public Health Institute, Oulu,4 and National Public Health Institute, Turku,5 Finland

Received 13 May 1998/Returned for modification 22 October 1998/Accepted 18 November 1998

Blood-based pneumolysin PCR was compared to blood culture and detection of pneumolysin immune complexes, as well as to detection of antibodies to pneumolysin and to C polysaccharide, in the diagnosis of pneumococcal infection in 75 febrile children. Invasive pneumococcal infection was suspected on clinical grounds in 67 of the febrile children, and viral infection was suspected on clinical grounds in 8 of the febrile children. In addition, 15 healthy persons were examined to test the specificity of the PCR assay. Plasma, serum, and leukocyte fractions were analyzed by PCR. The combination of all test results led to the diagnosis of pneumococcal infection in 25 patients. Pneumolysin PCR was positive in 44% of these children, an increase occurred in the pneumolysin antibodies in 39% and in the C polysaccharide antibodies in 30% of the patients; pneumolysin immune complexes were found in convalescent serum in 30%, pneumolysin immune complexes occurred in acute-phase serum samples in 16%, and a positive blood culture was found in 20% of the patients. None of the healthy controls had positive results by PCR. The results suggest that the diagnosis of Streptococcus pneumoniae infection from blood samples necessitates the use of several different assays. Pneumolysin PCR was the most sensitive assay, but its clinical value is reduced by the fact that three blood fractions are needed.

* Corresponding author. Mailing address: Research Unit, Department of Pediatrics, Turku University Hospital, Vähä Hämeenkatu 1 A 3, FIN-20500 Turku, Finland. Phone: 358-2-261-2486. Fax: 358-2-261-1485. E-mail: pia.toikka{at}utu.fi.

dagger Present address: Stanford University School of Medicine, Dept. of Microbiology and Immunology, PAVAHCS, Palo Alto, CA 94304.

Journal of Clinical Microbiology, March 1999, p. 633-637, Vol. 37, No. 3
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.


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