Liver transplantation for hepatic complications of Wilson's disease cures and corrects the underlying metabolic defect and leads to long-term survival in patients who present with either acute or chronic liver disease. Acute renal failure develops frequently in patients with fulminant Wilsonian hepatitis and typically resolves postoperatively.

Although the NOW test was originally introduced as a rapid pneumococcal antigen detection test for use with urine samples, it was successfully adapted to nasopharyngeal samples in the present study. The sensitivity, specificity, positive predictive value, and negative predictive value of the test were 92.2, 97.7, 95.9, and 95.5%, respectively. These results demonstrate that nasopharyngeal colonization with Streptococcus pneumoniae can be documented within 15 min of sample collection.Streptococcus pneumoniae is the leading bacterial cause of respiratory infections in children and of acute otitis media (AOM) in particular (8). Simultaneous cultures from nasopharynx and middle ear samples from patients with AOM demonstrate the same pathogen in a high proportion of cases (1)(2)(3)(4)(5)9). This study was designed to determine the reliability of a rapid pneumococcal antigen test in detecting the presence or absence of S. pneumoniae in the nasopharynxes of children with or without AOM.Children below the age of 15 years were enrolled at three office sites after we obtained informed consent. The enrollees had to be either healthy or ill with AOM. The children were enrolled without regard to sex or race. Children were excluded from the study if they had been treated with antibiotics within the past month. Nasopharyngeal samples were obtained with Mini-tip Culturettes (Becton Dickinson, Sparks, Md.). The specimens were cultured within 12 h of collection. The specimens were cultured on sheep blood agar and chocolate agar. The plates were incubated at 36°C in 5% CO 2 for 18 to 24 h. S. pneumoniae was identified by colonial morphology, Gram stain characteristics, optochin sensitivity, and bile solubility. Nontypeable Haemophilus influenzae was identified by growth on chocolate agar, colonial morphology, Gram strain characteristics, a growth requirement for X and V factors, and failure to agglutinate with typing antisera. Moraxella catarrhalis was identified by colonial morphology, Gram stain characteristics, and the biochemical reaction of butyrate esterase.The NOW test was obtained from Binex, Inc., Portland, Maine. It is an in vitro rapid immunochromatographic assay for the detection of S. pneumoniae cell wall polysaccharide in urine specimens from patients with symptoms of pneumonia. The test kit incorporates rabbit anti-S. pneumoniae antibody adsorbed onto a nitrocellulose membrane. If pneumococcal cell wall polysaccharide is in the specimen, an easily discernible pink-to-purple line appears within 15 min on the membrane. A control is included to ensure the validity of the test. We adapted the test to detect pneumococcal antigen in the nasopharynxes of children colonized with S. pneumoniae. The same swab used to collect the sample for culture was used for the NOW test. The procedure was conducted according to the directions in the kit. The sensitivity, specificity, positive predictive value, and negative predictive value of the NOW test were calculated for the total population and for the healthy and AOM subpopulations a...

The urinary excretion of the cell wall polysaccharide of Streptococcus pneumoniae was studied in 92 children with the NOW test. Cell wall polysaccharide was detected in 65% of pneumococcal carriers and in 10% of noncarriers. Excretion rates were similar in healthy children and in children with acute otitis media. The high rate of antigen excretion among nonill carriers suggests that colonization is a major source of urinary antigen in children.