Pneumococcal pneumonia in children less than 5 years: Are we underdiagnosing?

Abstract

Background: Streptococcus pneumoniae is a leading cause of bacterial pneumonia in children. Diagnosis of Pneumococcal pneumonia by culture methods is difficult, if antibiotics were taken before culture. The objectives of this study were 1-to evaluate the diagnostic yield of (BinaxNOW) antigen test, and culture methods compared to quantitative PCR, for the identification of Streptococcus pneumoniae in community-acquired pneumonia (CAP) children under 5 years, 2- and to assess the severity of Pneumococcal pneumonia. Methods: We enrolled 60 children with CAP, and 30 age and sex-matched healthy controls. For all patients, blood culture, respiratory specimen culture, qPCR, complete blood count and CRP were done. For both the patient group and control group, the urinary antigen test (BinaxNOW) was done. Patients were evaluated by RDS score. Results: The median age for patients and control were 9 ± 9.3 and 9.5 ± 13.5 months, respectively. PCR was positive in 12 (20%) out of 60 patients, indicating Pneumococcal pneumonia. Of them, 9 (15%) tested positive by BinaxNow, and one by positive culture of Streptococcus pneumoniae (1.2%). The RDS risk score identified significantly severe disease, and children higher TLC, more shift to the left and higher CRP, in Pneumococcal pneumonia group. Conclusions: Pneumococcal pneumonia presented with more severe disease. Culture methods were inferior to PCR and antigen test. The antigen test can be used as point of care rapid diagnostic test, for discriminating between children with and without Pneumococcal pneumonia; with the potential to impact patient care and improve antibiotic stewardship.

Keywords

• pneumococcal pneumonia
• pcr, binaxnow, streptococcus pneumoniae, children less than 5 years