Background Sensitivity of culture for the detection of Streptococcus pneumoniae is limited by prior antibiotic exposure. Immunochromatographic test (ICT) is highly sensitive and specific for pneumococcal antigen detection in the cerebrospinal fluid (CSF) of meningitis cases. We determined the specificity and sensitivity of culture, ICT, and polymerase chain reaction (PCR) and the effect of antibiotic exposure on their performance. Methods CSF specimens from suspected meningitis cases admitted to Dhaka Shishu Hospital, Bangladesh, were tested using culture, ICT and PCR. Additionally, 165 specimens collected from 69 pneumococcal cases after antibiotic treatment were tested. Results Of 1883 specimens tested, culture detected 9, quantitative PCR (qPCR) detected 184, and ICT detected 207 pneumococcal cases (including all culture and qPCR positives). In comparison to ICT, sensitivity of culture was 4.4% and of qPCR was 90.6%; both were 100% specific. After antibiotic exposure, culture sensitivity plummeted rapidly; conventional PCR and qPCR sensitivity disappeared after day 6 and 20, respectively. ICT detected pneumococcal antigen for >10 weeks. Conclusions While culture provides the most information about bacterial characteristics, in high antibiotic exposure settings, ICT exhibits maximum sensitivity. We recommend culture and ICT as mainstay for pneumococcal diagnosis and surveillance; qPCR can generate additional molecular data where possible.

中文翻译：

---

儿童脑脊液中肺炎球菌培养、抗原检测和聚合酶链反应检测的比较

背景 用于检测肺炎链球菌的培养敏感性受到先前抗生素暴露的限制。免疫层析检测 (ICT) 对脑膜炎病例脑脊液 (CSF) 中的肺炎球菌抗原检测具有高度敏感性和特异性。我们确定了培养、ICT 和聚合酶链式反应 (PCR) 的特异性和敏感性以及抗生素暴露对其性能的影响。方法 对孟加拉达卡石树医院收治的疑似脑膜炎病例的脑脊液标本进行培养、ICT 和 PCR 检测。此外，对抗生素治疗后从 69 例肺炎球菌病例中采集的 165 份标本进行了检测。结果 检测标本1883例，培养检出9例，定量PCR（qPCR）检出184例，ICT检出肺炎球菌病例207例（包括所有培养和qPCR阳性）。与 ICT 相比，培养的敏感性为 4.4%，qPCR 的敏感性为 90.6%；两者都是 100% 特定的。抗生素暴露后，培养敏感性迅速下降；常规 PCR 和 qPCR 敏感性分别在第 6 天和第 20 天后消失。ICT检测肺炎球菌抗原＞10周。结论 虽然培养提供了有关细菌特征的最多信息，但在高抗生素暴露环境中，ICT 表现出最大的敏感性。我们建议将培养和 ICT 作为肺炎球菌诊断和监测的主要手段；qPCR 可以在可能的情况下生成额外的分子数据。分别。ICT检测肺炎球菌抗原＞10周。结论 虽然培养提供了有关细菌特征的最多信息，但在高抗生素暴露环境中，ICT 表现出最大的敏感性。我们建议将培养和 ICT 作为肺炎球菌诊断和监测的主要手段；qPCR 可以在可能的情况下生成额外的分子数据。分别。ICT检测肺炎球菌抗原＞10周。结论 虽然培养提供了有关细菌特征的最多信息，但在高抗生素暴露环境中，ICT 表现出最大的敏感性。我们建议将培养和 ICT 作为肺炎球菌诊断和监测的主要手段；qPCR 可以在可能的情况下生成额外的分子数据。