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Journal of Clinical Microbiology, August 2005, p. 4037-4040, Vol. 43, No. 8
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.8.4037-4040.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Detection of Streptococcus pneumoniae Antigen in Bronchoalveolar Lavage Fluid Samples by a Rapid Immunochromatographic Membrane Assay

Jan A. Jacobs,^1* Ellen E. Stobberingh,¹ Elisa I. M. Cornelissen,¹ and Marjolein Drent²

Departments of Medical Microbiology,¹ Respiratory Medicine, University Hospital Maastricht, Maastricht, The Netherlands²

Received 30 November 2004/ Returned for modification 13 January 2005/ Accepted 2 May 2005

We conducted a retrospective study to evaluate an immunochromatographic membrane test (ICT), applied to bronchoalveolar lavage (BAL) fluid samples obtained in patients with suspected pneumonia, for the detection of Streptococcus pneumoniae antigen. The NOW Streptococcus pneumoniae test was assessed on 96 BAL fluid samples. Sensitivity was tested in 20 samples obtained from patients diagnosed as having pneumococcal pneumonia (growth of S. pneumoniae in blood cultures and/or in BAL fluid samples of 10⁴ CFU/ml). Specificity was tested in BAL fluid samples of nonpneumococcal etiology (n = 41) and in samples with no respiratory pathogen and a total bacterial count of <10⁴ CFU/ml (n = 35). Using the ICT, pneumococcal antigen was detected in 29 (30.2%) BAL fluid samples, with a sensitivity of 95.0% (95% confidence interval [CI], 90.6% to 99.4%) and a specificity of 86.8% (95% CI, 80.1% to 93.8%). The ICT was easy to perform and revealed unequivocal and reproducible results. No interference was observed with high cell counts, red blood cells, or elevated protein levels. Four out of 10 false-positive readings occurred in samples with S. pneumoniae counts below the 10⁴ CFU/ml threshold limit of pneumonia. In BAL fluid samples obtained after pneumococcal bacteremia, positive test results were found for up to 35 days after bacteremia. The ICT test applied to BAL fluid specimens is reproducible and accurate in the diagnosis of pneumococcal antigen. Further studies are required to establish the impact of the ICT on patient care.

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* Corresponding author. Mailing address: Department of Medical Microbiology, University Hospital of Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. Phone: 31-43-387 46 44. Fax: 31-43-387 66 43. E-mail: jja{at}lmib.azm.nl.

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Journal of Clinical Microbiology, August 2005, p. 4037-4040, Vol. 43, No. 8
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.8.4037-4040.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

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