Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 4
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Memish, Ziad A. Al-Tawfiq, Jaffar A. Almasri, Malak Akkad, Nadia Yezli, Saber Turkestani, Abdulhafeez van der Linden, Mark and Assiri, Abdullah 2016. A cohort study of the impact and acquisition of naspharyngeal carriage of Streptococcus pneumoniae during the Hajj. Travel Medicine and Infectious Disease, Vol. 14, Issue. 3, p. 242.

    McCullers, J.A. 2013. Do specific virus–bacteria pairings drive clinical outcomes of pneumonia?. Clinical Microbiology and Infection, Vol. 19, Issue. 2, p. 113.

    Troy, Lauren K. Wong, Keith K. H. and Barnes, David J. 2013. Prevalence and Utility of Positive Pneumococcal Urinary Antigen Tests in Australian Patients with Community-Acquired Pneumonia. ISRN Infectious Diseases, Vol. 2013, p. 1.

    Werno, Anja M. Lewis, John G. George, Peter M. and Murdoch, David R. 2012. Immune Reactivity of Four Monoclonal and Two Polyclonal Antibodies Raised Against Recombinant Pneumococcal Surface Adhesin A. Hybridoma, Vol. 31, Issue. 3, p. 168.


Use of serology and urine antigen detection to estimate the proportion of adult community-acquired pneumonia attributable to Streptococcus pneumoniae

  • J. P. WATT (a1), J. C. MOÏSI (a1), R. L. A. DONALDSON (a1), R. REID (a1), S. FERRO (a2), C. G. WHITNEY (a3), M. SANTOSHAM (a1) and K. L. O'BRIEN (a1)
  • DOI:
  • Published online: 25 March 2010

Streptococcus pneumoniae is a common cause of community-acquired pneumonia (CAP) but existing diagnostic tools have limited sensitivity and specificity. We enrolled adults undergoing chest radiography at three Indian Health Service clinics in the Southwestern United States and collected acute and convalescent serum for measurement of PsaA and PspA titres and urine for pneumococcal antigen detection. Blood and sputum cultures were obtained at the discretion of treating physicians. We compared findings in clinical and radiographic CAP patients to those in controls without CAP. Urine antigen testing showed the largest differential between CAP patients and controls (clinical CAP 13%, radiographic CAP 17%, control groups 2%). Serological results were mixed, with significant differences between CAP patients and controls for some, but not all changes in titre. Based on urine antigen and blood culture results, we estimated that 11% of clinical and 15% of radiographic CAP cases were due to pneumococcus in this population.

Corresponding author
*Author for correspondence: J. P. Watt, M.D., M.P.H., Center for American Indian Health621 N. Wolfe St.Baltimore, MD21205, USA. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1.ML Jackson , The burden of community-acquired pneumonia in seniors: results of a population-based study. Clinical Infectious Diseases 2004; 39: 1642–1450.

3.HM Foy , Rates of pneumonia during influenza epidemics in Seattle, 1964 to 1975. Journal of the American Medical Association 1979; 241: 253258.

5.BJ Marston , Incidence of community-acquired pneumonia requiring hospitalization. Results of a population-based active surveillance study in Ohio. The Community-Based Pneumonia Incidence Study Group. Archives of Internal Medicine 1997; 157: 17091718.

6.J Almirall , Epidemiology of community-acquired pneumonia in adults: a population-based study. European Respiratory Journal 2000; 15: 757763.

7.JP Watt , Measuring the incidence of adult community-acquired pneumonia in a Native American community. Epidemiology and Infection. Published online: 8 January 2010. doi:10.1017/S0950268809991464.

8.E Vuori , Etiology of pneumonia and other common childhood infections requiring hospitalization and parenteral antimicrobial therapy. SE-TU Study Group. Clinical Infectious Diseases 1998; 27: 566572.

9.IM Forgie , Etiology of acute lower respiratory tract infections in children in a rural community in The Gambia. Pediatric Infectious Diseases Journal 1992; 11: 466473.

10.E Vuori-Holopainen , H Peltola . Reappraisal of lung tap: review of an old method for better etiologic diagnosis of childhood pneumonia. Clinical Infectious Diseases 2001; 32: 715726.

11.AG Falade , Bacterial isolates from blood and lung aspirate cultures in Gambian children with lobar pneumonia. Annals of Tropical Paediatrics 1997; 17: 315319.

12.JA Scott , Diagnosis of pneumococcal pneumonia by psaA PCR analysis of lung aspirates from adult patients in Kenya. Journal of Clinical Microbiology 2003; 41: 25542559.

13.E Barrett-Connor . The nonvalue of sputum culture in the diagnosis of pneumococcal pneumonia. American Review of Respiratory Diseases 1971; 103: 845848.

14.S Ewig , Applying sputum as a diagnostic tool in pneumonia: limited yield, minimal impact on treatment decisions. Chest 2002; 121: 14861492.

15.JA Scott , Validation of immunoglobulin G enzyme-linked immunosorbent assay for antibodies to pneumococcal surface adhesin A in the diagnosis of pneumococcal pneumonia among adults in Kenya. Journal of Infectious Diseases 2002; 186: 220226.

16.JA Scott , Diagnosis of pneumococcal pneumonia in epidemiological studies: evaluation in Kenyan adults of a serotype-specific urine latex agglutination assay. Clinical Infectious Diseases 1999; 28: 764769.

17.DM Musher , Antibody to capsular polysaccharide of Streptococcus pneumoniae at the time of hospital admission for Pneumococcal pneumonia. Journal of Infectious Diseases 2000; 182: 158167.

18.T Ishida , A 3-year prospective study of a urinary antigen-detection test for Streptococcus pneumoniae in community-acquired pneumonia: utility and clinical impact on the reported etiology. Journal of Infection and Chemotherapy 2004; 10: 359363.

19.MD Smith , Rapid diagnosis of bacteremic pneumococcal infections in adults by using the Binax NOW Streptococcus pneumoniae urinary antigen test: a prospective, controlled clinical evaluation. Journal of Clinical Microbiology 2003; 41: 28102813.

20.F Gutierrez , Evaluation of the immunochromatographic Binax NOW assay for detection of Streptococcus pneumoniae urinary antigen in a prospective study of community-acquired pneumonia in Spain. Clinical Infectious Diseases 2003; 36: 286292.

22.BinaxNOW®. S. pneumoniae package insert. Portland, ME, USA: Binax, 2005.

24.B Roson , Contribution of a urinary antigen assay (Binax NOW) to the early diagnosis of pneumococcal pneumonia. Clinical Infectious Diseases 2004; 38: 222226.

25.TM File . Community-acquired pneumonia. Lancet 2003; 362: 19912001.

26.PY Bochud , Community-acquired pneumonia. A prospective outpatient study. Medicine 2001; 80: 7587.

27.M Falguera , Nonsevere community-acquired pneumonia: correlation between cause and severity or comorbidity. Archives of Internal Medicine 2001; 161: 18661872.

29.DM Musher , Nonspecificity of assaying for IgG antibody to pneumolysin in circulating immune complexes as a means to diagnose pneumococcal pneumonia. Clinical Infectious Diseases 2001; 32: 534538.

30.JP Watt , Nasopharyngeal versus oropharyngeal sampling for detection of pneumococcal carriage in adults. Journal of Clinical Microbiology 2004; 42: 4974–496.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *