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• W2415989919 abstract "To the Editors: Invasive infection with Streptococcus pneumoniae is the second commonest cause of meningitis and septicemia in childhood, accounting for 10–15% of cases in the United Kingdom.1,2 Isolation of S. pneumoniae from a normally sterile site remains the standard for diagnosis. Blood culture sensitivity is low (approximately 45%) and decreases further when antibiotics have been administered (approximately 20%).3 Despite its accuracy and potential to detect pneumococcus in culture-negative patients, the use of molecular testing for S. pneumoniae is not widespread and not yet recommended as part of routine investigations of suspected septicemia.1,2 We tested retrospectively 117 blood specimens for S. pneumoniae lytA using previously published polymerase chain reaction (PCR) assays.4 These specimens were collected from children with suspected meningitis or septicemia as part of an ethically approved study on the diagnostic accuracy of Neisseria meningitidis Loop Mediated Isothermal Assay.5 Four of the 117 children tested had pneumococcal lytA detected by PCR. Only 2 of these had invasive pneumococcal disease confirmed by blood culture. The 2 children who were culture negative had clinical signs of septicemia: a 10-month-old boy with fever, vomiting and listlessness who required fluid resuscitation and admission to intensive care; a 2-year-old girl with fever, cough, poor feeding, poor perfusion and focal chest signs. Evaluating lytA PCR as a confirmatory test for pneumococcus is complicated because it seems to perform better than the standard traditional culture. The children included in this study were defined as “those whom the attending clinician suspected as having meningitis or septicemia.” Review of the clinical details of the children in this study in combination with a positive lytA PCR make it likely that these children had invasive pneumococcal disease that conventional culture methods failed to diagnose. Although our study was small and pneumococcal disease was rare, these data suggest that addition of lytA PCR to the routine investigations of children presenting with signs of septicemia and meningitis is likely to improve laboratory diagnosis of this serious infection. This is clinically a very desirable outcome as treatment for invasive pneumococcal disease requires a longer course of treatment than meningococcal disease.2 We believe that reviewed National Institute for Health and Care Excellence and other guidelines should consider recommending this test to the panel of investigations of children with suspected meningitis or septicemia. Thomas Walter Bourke, MD Centre for Infection and Immunity Queen’s University Belfast Royal Belfast Hospital for Sick Children Belfast Health & Social Care Trust Derek James. Fairley, PhD Centre for Infection and Immunity Queen’s University Belfast Regional Virus Laboratory Department of Microbiology Belfast Health & Social Care Trust James Patrick McKenna, PhD Peter Valentine Coyle, MD Regional Virus Laboratory Department of Microbiology Belfast Health & Social Care Trust Michael David Shields, MD Centre for Infection and Immunity Queen’s University Belfast Royal Belfast Hospital for Sick Children Belfast Health & Social Care Trust Belfast, United Kingdom" @default.
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• W2415989919 date "2015-11-01" @default.
• W2415989919 modified "2023-09-26" @default.
• W2415989919 title "Clinical Evaluation of Streptococcus pneumoniae Polymerase Chain Reaction in Children with Suspected Septicemia" @default.
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• W2415989919 doi "https://doi.org/10.1097/inf.0000000000000877" @default.
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