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Journal of Clinical Microbiology, October 2005, p. 4972-4976, Vol. 43, No. 10
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.10.4972-4976.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Diagnosis of Invasive Pneumococcal Infection by Serotype-Specific Urinary Antigen Detection

Health Protection Agency South West Regional Laboratory, Bristol Royal Infirmary, Bristol BS2 8HW,¹ Vaccine Evaluation Unit, Health Protection Agency South West, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN,² Respiratory and Systemic Infection Laboratory, Centre for Infection, Health Protection Agency, 61 Colindale Avenue, London NW9 5HT,³ Department of Microbiology, Taunton and Somerset Hospital, Taunton TA1 5DB, United Kingdom⁴

Received 16 May 2005/ Returned for modification 19 June 2005/ Accepted 17 July 2005

Widespread use of conjugate pneumococcal polysaccharide-protein vaccines may alter the spectrum of pneumococci producing invasive disease. Novel sensitive diagnostic methods would be valuable for monitoring the epidemiology of pneumococcal disease within populations and vaccine recipients. Ideally, these methods should allow determination of the serotype of the infecting clone. Serotype-specific enzyme-linked immunosorbent assays (ELISA) for 13 capsular polysaccharides (types 1, 3, 4, 5, 6A, 6B, 7A, 9V, 14, 18C, 19A, 19F, and 23F) were developed. Experiments with pure capsular polysaccharide demonstrated that the assays were sensitive (0.01 to 1.0 ng/ml) and specific. These assays were used to detect capsular polysaccharide in urine from 263 adult patients with proven (blood culture-positive) invasive pneumococcal disease and pneumonia of unknown etiology and from patients with positive blood cultures yielding bacteria other than pneumococci (control group). Among 76 patients with invasive pneumococcal disease from whom blood culture isolates had been serotyped, 62 (82%) had infections with pneumococci of serotypes represented in the ELISA panel. Capsular antigen matching the serotype of the blood culture isolate was detected in the urine of 52 of these patients, giving a sensitivity of 83.9% for the target serotypes. The tests were significantly more sensitive for urine from patients with pneumococcal pneumonia (89.8%) than for urine from patients with nonpneumonic invasive infection (61.5%; P < 0.05). Data from the control group indicated a specificity of 98.8%. These assays should prove valuable in epidemiological investigation of invasive pneumococcal infection in adults, particularly if combined with a sensitive C-polysaccharide detection assay to screen for positive samples.

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