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A Case–Control Study to Assess the Urinary Pneumococcal Antigen Test in Childhood Pneumonia

Urinary pneumococcal antigen is a rapid noninvasive test that may indicate recent invasive pneumococcal infection or carriage, and guide appropriate antibiotic therapy. It has good sensitivity (100%) and (although limited specificity, 56%) in children with suspected pneumococcal disease but is confounded as a diagnostic test by nasopharyngeal carriage where up to 21% may be positive. Urinary pneumococcal antigen may also be positive in 4% healthy nasopharyngeal culturenegative children. In fact, because of the increased sensitivity of polymerase chain reaction (PCR) compared with culture, it is likely that nasopharyngeal culturenegative children would have pneumococcal carriage if tested by PCR. Thus, a positive urinary antigen in a child with pneumonia and no pneumococcal nasopharyngeal carriage by PCR is likely to reflect invasive pneumococcal disease. We therefore aimed to investigate the association of urinary pneumococcal antigen with pneumococcal infection in childhood pneumonia.