Comparison of Culture, Antigen Test, and Polymerase Chain Reaction for Pneumococcal Detection in Cerebrospinal Fluid of Children
Open accessAbstract
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.
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The reported sensitivity of PCR for pneumococcal meningitis is high and reached 100% in the majority of studies, with a median of 100% and range 79%-100%.
“The reported sensitivity of PCR for pneumococcal meningitis is high and reached 100% in the majority of conducted studies (median of 100%, range 79%–100%) (Table 1; see also Table S1 in the supplemental material) (49–58).”
From Molecular diagnostics in cerebrospinal fluid for the diagnosis of central nervous system infections (2024) · cites this paper as [53]
The Results, under “Sensitivity and Specificity” (page not provided), report high qPCR sensitivity: 100% compared with culture, but 90.64% compared with the antigen test. This single study does not establish that most studies reached 100% or substantiate the stated median and 79%–100% range across studies. (LLM, conf=0.88)
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Molecular diagnostics in cerebrospinal fluid for the diagnosis of central nervous system infections
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“Several studies found that PCR for S. pneumoniae provided additional diagnostic value in culture-negative bacterial meningitis (49, 50, 53, 55).”
- Authors
- Hasanuzzaman, M., Saha, S., Malaker, R., Rahman, H., Sajib, M. S. I., Das, R. C., Islam, M., Hamer, D. H., Darmstadt, G. L., & Saha, S. K.
- Affiliations
- Child Health Research Foundation (BD)
- Bangladesh Shishu (Children) Hospital & Institute (BD)
- Boston University (US)
- Stanford Medicine (US)
- Corresponding author
- Saha, Senjuti
- ORCID
- Venue
- The Journal of Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-09-01
- Volume
- 224
- Issue
- Supplement_3
- Pages
- S209-S217
- ISSN
- 0022-1899 (ISSN-L)
- 1537-6613
- PMC
- PMC8409532
- OpenAlex
- W3196640998
- Cited by
- 15
- References
- 29
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 2 · 2023: 3 · 2022: 1
- FWCI
- 1.05
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Journal of Infectious Diseases (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Greater South Information System
- Funders
- GAVI Alliance
- World Health Organization (201588766, 201233523, 201022732, 200749550, 201686542, 202048618, 202048971)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
- Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Keywords
- Streptococcus pneumoniae, pneumococcal meningitis, cerebrospinal fluid, pneumococcal antigen detection, lateral flow immunoassay, cultural sensitivity, antibiotic exposure, real-time PCR, sensitivity and specificity, pediatric meningitis
- MeSH terms
- Anti-Bacterial Agents, Antigens, Bacterial, Bangladesh, Cerebrospinal Fluid, Child, Chromatography, Affinity, Humans, Infant, Meningitis, Pneumococcal, Sensitivity and Specificity, Streptococcus pneumoniae, Real-Time Polymerase Chain Reaction, Public Health Surveillance
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