Skip to main content
NCBI home page
Epidemiology and Infection logoLink to Epidemiology and Infection
. 1993 Jun;110(3):621–631. doi: 10.1017/s0950268800051049

Oropharyngeal production of pneumococcal capsular antigen and the potential for contamination of expectorated sputum samples in pneumococcal pneumonia.

P Venkatesan 1, K Sole 1, C Tang 1, J T Macfarlane 1, R G Finch 1
PMCID: PMC2272292  PMID: 8519327

Abstract

The presence of pneumococcal capsular antigen (PCA) in the oropharynx was sought in subjects without respiratory tract infection. Saliva specimens from 239 subjects were analysed by counter-current immunoelectrophoresis using 'Omniserum'. 15.5% gave positive reactions but only 24% of positive samples were typable and therefore due to pneumococcal or pneumococcal-like antigens. Given that oropharyngeal production of antigens occurs we investigated whether PCA in expectorated sputum arose from oropharyngeal contamination. Sixteen patients with pneumococcal pneumonia, and with sputum positive for PCA, were investigated in detail. On the basis of serotyping and concentration the PCA in sputum was thought to arise from the lower respiratory tract in all cases. This was confirmed by a simple, novel approach involving the comparison of concentrations in concomitant samples of saliva and sputum. Thus while oropharyngeal production of antigens poses a potential diagnostic problem the latter approach can be used to exclude contamination.

Full text

PDF
621

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Austrian R. Some aspects of the pneumococcal carrier state. J Antimicrob Chemother. 1986 Jul;18 (Suppl A):35–45. doi: 10.1093/jac/18.supplement_a.35. [DOI] [PubMed] [Google Scholar]
  2. Coonrod J. D., Drennan D. P. Pneumococcal pneumonia: capsular polysaccharide antigenemia and antibody responses. Ann Intern Med. 1976 Mar;84(3):254–260. doi: 10.7326/0003-4819-84-3-254. [DOI] [PubMed] [Google Scholar]
  3. El-Refaie M., Dulake C. Counter-current immunoelectrophoresis for the diagnosis of pneumococcal chest infection. J Clin Pathol. 1975 Oct;28(10):801–806. doi: 10.1136/jcp.28.10.801. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Forgie I. M., O'Neill K. P., Lloyd-Evans N., Leinonen M., Campbell H., Whittle H. C., Greenwood B. M. Etiology of acute lower respiratory tract infections in Gambian children: I. Acute lower respiratory tract infections in infants presenting at the hospital. Pediatr Infect Dis J. 1991 Jan;10(1):33–41. doi: 10.1097/00006454-199101000-00008. [DOI] [PubMed] [Google Scholar]
  5. Forgie I. M., O'Neill K. P., Lloyd-Evans N., Leinonen M., Campbell H., Whittle H. C., Greenwood B. M. Etiology of acute lower respiratory tract infections in Gambian children: II. Acute lower respiratory tract infection in children ages one to nine years presenting at the hospital. Pediatr Infect Dis J. 1991 Jan;10(1):42–47. doi: 10.1097/00006454-199101000-00009. [DOI] [PubMed] [Google Scholar]
  6. Hendley J. O., Sande M. A., Stewart P. M., Gwaltney J. M., Jr Spread of Streptococcus pneumoniae in families. I. Carriage rates and distribution of types. J Infect Dis. 1975 Jul;132(1):55–61. doi: 10.1093/infdis/132.1.55. [DOI] [PubMed] [Google Scholar]
  7. Holmberg H., Danielsson D., Hardie J., Krook A., Whiley R. Cross-reactions between alpha-streptococci and Omniserum, a polyvalent pneumococcal serum, demonstrated by direct immunofluorescence, immunoelectroosmophoresis, and latex agglutination. J Clin Microbiol. 1985 May;21(5):745–748. doi: 10.1128/jcm.21.5.745-748.1985. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Howard J. G., Christie G. H., Jacob M. J., Elson J. Studies on immunological paralysis. 3. Recirculation and antibody-neutralizing activity of 14C-labelled type 3 pneumococcal polysaccharide in paralysed mice. Clin Exp Immunol. 1970 Oct;7(4):583–596. [PMC free article] [PubMed] [Google Scholar]
  9. Jalonen E., Paton J. C., Koskela M., Kerttula Y., Leinonen M. Measurement of antibody responses to pneumolysin--a promising method for the presumptive aetiological diagnosis of pneumococcal pneumonia. J Infect. 1989 Sep;19(2):127–134. doi: 10.1016/s0163-4453(89)91864-1. [DOI] [PubMed] [Google Scholar]
  10. Krook A., Fredlund H., Holmberg H. Diagnosis of pneumococcal pneumonia by detection of antigen in saliva. Eur J Clin Microbiol. 1986 Dec;5(6):639–642. doi: 10.1007/BF02013288. [DOI] [PubMed] [Google Scholar]
  11. Macfarlane J. T., Finch R. G., Ward M. J., Macrae A. D. Hospital study of adult community-acquired pneumonia. Lancet. 1982 Jul 31;2(8292):255–258. doi: 10.1016/s0140-6736(82)90334-8. [DOI] [PubMed] [Google Scholar]
  12. Macfarlane J. Community-acquired pneumonia. Br J Dis Chest. 1987 Apr;81(2):116–127. doi: 10.1016/0007-0971(87)90128-8. [DOI] [PubMed] [Google Scholar]
  13. Ortqvist A., Jönsson I., Kalin M., Krook A. Comparison of three methods for detection of pneumococcal antigen in sputum of patients with community-acquired pneumonia. Eur J Clin Microbiol Infect Dis. 1989 Nov;8(11):956–961. doi: 10.1007/BF01967565. [DOI] [PubMed] [Google Scholar]
  14. Parkinson A. J., Rabiego M. E., Sepulveda C., Davidson M., Johnson C. Quantitation of pneumococcal C polysaccharide in sputum samples from patients with presumptive pneumococcal pneumonia by enzyme immunoassay. J Clin Microbiol. 1992 Feb;30(2):318–322. doi: 10.1128/jcm.30.2.318-322.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Simberkoff M. S., Cross A. P., Al-Ibrahim M., Baltch A. L., Geiseler P. J., Nadler J., Richmond A. S., Smith R. P., Schiffman G., Shepard D. S. Efficacy of pneumococcal vaccine in high-risk patients. Results of a Veterans Administration Cooperative Study. N Engl J Med. 1986 Nov 20;315(21):1318–1327. doi: 10.1056/NEJM198611203152104. [DOI] [PubMed] [Google Scholar]
  16. Sjögren A. M., Holmberg H., Krook A. Etiologic diagnosis of pneumonia by antigen detection: crossreactions between pneumococcal C-polysaccharide and oral microorganisms. Diagn Microbiol Infect Dis. 1987 Mar;6(3):239–248. doi: 10.1016/0732-8893(87)90018-6. [DOI] [PubMed] [Google Scholar]
  17. Tugwell P., Greenwood B. M. Pneumococcal antigen in lobar pneumonia. J Clin Pathol. 1975 Feb;28(2):118–123. doi: 10.1136/jcp.28.2.118. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Van der Auwera P., André A., Bulliard G., Legrand J. C., Gordts B., Van Landuyt H., Schuyteneer F. Comparison of latex agglutination and counterimmunoelectrophoresis in the diagnosis of acute Streptococcus pneumoniae infections. Eur J Clin Microbiol. 1983 Dec;2(6):534–540. doi: 10.1007/BF02016561. [DOI] [PubMed] [Google Scholar]
  19. Venkatesan P., Gladman J., Macfarlane J. T., Barer D., Berman P., Kinnear W., Finch R. G. A hospital study of community acquired pneumonia in the elderly. Thorax. 1990 Apr;45(4):254–258. doi: 10.1136/thx.45.4.254. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Woodhead M. A., Macfarlane J. T., McCracken J. S., Rose D. H., Finch R. G. Prospective study of the aetiology and outcome of pneumonia in the community. Lancet. 1987 Mar 21;1(8534):671–674. doi: 10.1016/s0140-6736(87)90430-2. [DOI] [PubMed] [Google Scholar]

Articles from Epidemiology and Infection are provided here courtesy of Cambridge University Press

RESOURCES