New Technique (the NOW Test) for Rapid Detection of
            <i>Streptococcus pneumoniae</i>
            in the Nasopharynx

Faden, Howard; Heimerl, Michael; Goodman, Gail W.; Winkelstein, Peter; Varma, Chelikani

doi:10.1128/jcm.40.12.4748-4749.2002

Cited by 16 publications

(14 citation statements)

References 6 publications

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“…Streptococcus pneumoniae in the Nasopharynx Faden et al recently reported the use of the NOW immunochromatographic test to rapidly detect nasopharyngeal colonization with Streptococcus pneumoniae (1). While the specificity of the test in this study was relatively high (97.7%), it is important to be aware that oropharyngeal colonizing bacteria other than S. pneumoniae may also produce positive results with this test.…”

Section: Immunochromatographic Test For Rapid Detection Ofmentioning

confidence: 79%

Immunochromatographic Test for Rapid Detection of Streptococcus pneumoniae in the Nasopharynx

Murdoch

Reller

2003

J Clin Microbiol

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Faden et al. recently reported the use of the NOW immunochromatographic test to rapidly detect nasopharyngeal colonization with Streptococcus pneumoniae (1). While the specificity of the test in this study was relatively high (97.7%), it is important to be aware that oropharyngeal colonizing bacteria other than S. pneumoniae may also produce positive results with this test. Specifically, Streptococcus mitis shares the antigen against which the NOW test is directed. This cross-reaction is recorded by the manufacturer in the product instructions and is supported by the findings from our own research.We noted a relatively high rate of positive results when evaluating the NOW test as an alternative method for rapidly identifying S. pneumoniae isolates. We tested 96 S. pneumoniae isolates and 83 alpha-hemolytic nonpneumococcal streptococcal isolates obtained mainly from blood cultures and respiratory samples. All S. pneumoniae isolates were positive by the NOW test, as well as 20 of the nonpneumococcal isolates. The latter isolates were all bile insoluble and optochin resistant and were identified to species level by the API 20 Strep identification system (bioMerieux Vitek, Inc., Hazelwood, Mo.), supplemented by conventional test procedures. Eighteen of these isolates were identified as belonging to the S. mitis group, and the remaining two isolates were identified as Gemella morbillorum and Gemella haemolysans.When the NOW test is used to detect S. pneumoniae antigen in urine from patients with pneumonia, this cross-reaction with S. mitis is unlikely to be important. In contrast, anyone using the NOW test to detect nasopharyngeal colonization should be aware of this possible source of false-positive results. Indeed, it is perhaps surprising that the false-positive rate was not higher in the study by Faden et al. Author's Reply I thank Drs. Murdoch and Reller for their timely comments. We were aware of the potential for cross-reactivity with S. mitis when we began the study, and we were very surprised at the lack of false-positive results. All of our specimens were collected from the nasopharynx as opposed to the oropharynx or throat. It is quite possible that S. mitis may have been relatively uncommon in our population in comparison to S. pneumoniae. It is also quite possible that S. mitis is found relatively less frequently in the nasopharynx than in the oropharynx. I think that the test deserves further clinical study as a rapid test for S. pneumoniae in the airway to validate the high sensitivity and specificity demonstrated in our study.

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Section: Immunochromatographic Test For Rapid Detection Ofmentioning

confidence: 79%

Immunochromatographic Test for Rapid Detection of Streptococcus pneumoniae in the Nasopharynx

Murdoch

Reller

2003

J Clin Microbiol

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“…The Binax NOW test also failed to identify a case of pneumococcal meningitis. The causative agent was detected by PCR alone, suggesting a low bacterial count; the manufacturer specifies a detection limit of about 10 5 CFU/ml in cerebrospinal fluid. Furthermore, urine samples can remain positive for weeks after a pneumococcal infection (39), and the test will be affected if the patient has recently been vaccinated with a pneumococcal vaccine.…”

Section: Discussionmentioning

confidence: 99%

“…The antigen against which the Binax NOW test reacts is a cell wall polysaccharide on S. pneumoniae, which is present in all clinically relevant strains. In this study, middle ear fluid, nasopharyngeal secretions, and cerebrospinal fluid were tested as previously described (10,11,36). The Binax NOW test was also adapted for bone tissue by placing the tissue in a tube with phosphate-buffered saline (1 ml) and vortexing it for 30 s. The sample was thereafter mixed with the reaction buffer as described above.…”

Section: Methodsmentioning

confidence: 99%

The Binax NOW Test as a Tool for Diagnosis of Severe Acute Otitis Media and Associated Complications

Gisselsson-Solén

Bylander²,

Wilhelmsson

et al. 2007

J Clin Microbiol

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The diagnosis of acute otitis media (AOM) is often difficult, depending heavily on the experience and skills of the examiner. However, it is important to identify episodes of AOM that involve the risk of complications and to treat these episodes appropriately. The present study was performed in order to evaluate the use of a rapid antigen assay for Streptococcus pneumoniae, the Binax NOW test, as a diagnostic tool in patients with severe AOM and associated complications. The study included 70 patients with 74 episodes of AOM, 18 of them with complications. Cultures, Binax NOW tests, and a PCR assay were performed on nasopharyngeal secretions, middle ear fluid, and in some cases mastoid bone, cerebrospinal fluid, and urine. According to culture and PCR of the middle ear fluid, 30 (41%) of the episodes were caused by S. pneumoniae. The Binax NOW test was positive in 24 of these episodes (80%). It identified pneumococcal AOM independent of antibiotic treatment, and it was easily adapted to bone tissue. The test yielded sensitivity, specificity, and positive and negative predictive values for middle ear specimens of 85%, 100%, 100%, and 89%, respectively. The corresponding positive and negative values for predicting the bacterial etiology with nasopharyngeal secretions were 51% and 75%. This study showed that the Binax NOW test is a useful diagnostic tool for patients with severe AOM with or without complications.Acute purulent otitis media (AOM) is the most common bacterial infection diagnosed among children. By 3 years of age, up to 85% of all children have experienced at least one episode of AOM (40), and 15 to 20% of the children suffer from recurrent episodes (1, 7).The most frequent microbiological cause of AOM is Streptococcus pneumoniae (26 to 48%), followed by Haemophilus influenzae (15 to 41%), Moraxella catarrhalis (23 to 25%), and Streptococcus pyogenes (4 to 8%) (2,3,20,27). S. pneumoniae and S. pyogenes are the two most virulent pathogens of the middle ear, and they are the leading causes of complications such as mastoiditis, labyrinthitis, and meningitis (15,22,23,28,38).AOM is the single most common reason for prescribing antibiotics to children (12, 24). The antibiotic load and selective pressure in the youngest age groups are consequently high, and clinical problems with antibiotic resistance have emerged (5, 41). The routine use of antimicrobial drugs in AOM treatment has been reevaluated in recent years, and watchful waiting has become an alternative (34). Watchful waiting is, however, not without risk. A safer approach is to use stricter diagnostic criteria for AOM, to improve the diagnostic tools, and to treat only those patients who are the least likely to recover spontaneously.The diagnosis of AOM, especially in young children, is often difficult and inadequate (4,12,33,42). Previous studies have shown that physicians are uncertain of the diagnosis in 40% of cases (31), and general practitioners are more likely to diagnose AOM than are otorhinolaryngologists (4). Furthermore, about 49 to 88% ...

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“…The test result is not affected by antimicrobial treatment as easily as bacterial culture because the test detects the Cpolysaccharide of S. pneumoniae, which is shared by all pneumococcal serotypes, and does not need living bacteria [9,10]. Previously, two small studies in young children have suggested that the Binax NOW test might be reliable in detection of S. pneumoniae from nasopharyngeal samples [2,11]. However, sampling deeply from the nasopharynx is unpleasant for the patient and not feasible without experience, therefore sampling from the anterior nose would be more realistic in office practice.…”

Section: Introductionmentioning

confidence: 95%

“…meningitis, bacteremia, pneumonia, and acute otitis media. Of these infections, acute otitis media is the most common, affecting roughly 80% of children under three years of age [1,2]. Up to half of the acute otitis media cases are caused by S. pneumoniae [3], which is particularly involved in severe and complicated cases [4,5].…”

Section: Introductionmentioning

confidence: 99%

Detection of Streptococcus pneumoniae carriage by the Binax NOW test with nasal and nasopharyngeal swabs in young children

Vuorenoja

Jalava

Lindholm

et al. 2011

Eur J Clin Microbiol Infect Dis

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The rapid detection of carriage of Streptococcus pneumoniae could assist in the management of pneumococcal infection, such as acute otitis media. We evaluated the reliability of the Binax NOW test in the exclusion and detection of pneumococcal carriage by nasal samples from 139 children and using nasopharyngeal samples from 250 children (aged 6-35 months) with respiratory infection with or without acute otitis media. The Binax NOW test results were compared with culture-based detection of carriage of S. pneumoniae. The Binax NOW test from the nasal samples had a sensitivity of 95%, a specificity of 78%, and the positive and negative predictive values were 83 and 93%, respectively; and for the nasopharyngeal samples the corresponding numbers were 88%, 95%, 96%, and 87%. When rapid knowledge of the carriage status of S. pneumoniae is needed, the Binax NOW test is a reliable method for the exclusion of carriage using nasal sampling, and in the detection of carriage using nasopharyngeal sampling.

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New Technique (the NOW Test) for Rapid Detection of Streptococcus pneumoniae in the Nasopharynx

Cited by 16 publications

References 6 publications

Immunochromatographic Test for Rapid Detection of Streptococcus pneumoniae in the Nasopharynx

Immunochromatographic Test for Rapid Detection of Streptococcus pneumoniae in the Nasopharynx

The Binax NOW Test as a Tool for Diagnosis of Severe Acute Otitis Media and Associated Complications

Detection of Streptococcus pneumoniae carriage by the Binax NOW test with nasal and nasopharyngeal swabs in young children

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