Morpeth SC
Deloria Knoll M
Scott JAG
Park DE
Watson NL
Baggett HC
Brooks WA
Feikin DR
Hammitt LL
Howie SRC
Kotloff KL
Levine OS
Madhi SA
O'Brien KL
Thea DM
Adrian PV
Ahmed D
Antonio M
Bunthi C
DeLuca AN
Driscoll AJ
Githua LP
Higdon MM
Kahn G
Karani A
Karron RA
Kwenda G
Makprasert S
Mazumder R
Moore DP
Mwansa J
Nyongesa S
Prosperi C
Sow SO
Tamboura B
Whistler T
Zeger SL
Murdoch DR
Perch Study Group
Clin Infect Dis. 2017;64S347-S356
BACKGROUND. We investigated the performance of polymerase chain reaction (PCR) on blood in the diagnosis of pneumococcal pneumonia among children from 7 low- and middle-income countries. METHODS. We tested blood by PCR for the pneumococcal autolysin gene in children aged 1-59 months in the Pneumonia Etiology Research for Child Health (PERCH) study. Children had World Health Organization-defined severe or very severe pneumonia or were age-frequency-matched community controls. Additionally, we tested blood from general pediatric admissions in Kilifi, Kenya, a PERCH site. The proportion PCR-positive was compared among cases with microbiologically confirmed pneumococcal pneumonia (MCPP), cases without a confirmed bacterial infection (nonconfirmed), cases confirmed for nonpneumococcal bacteria, and controls. RESULTS. In PERCH, 7.3% (n = 291/3995) of cases and 5.5% (n = 273/4987) of controls were blood pneumococcal PCR-positive (P < .001), compared with 64.3% (n = 36/56) of MCPP cases and 6.3% (n = 243/3832) of nonconfirmed cases (P < .001). Blood pneumococcal PCR positivity was higher in children from the 5 African countries (5.5%-11.5% among cases and 5.3%-10.2% among controls) than from the 2 Asian countries (1.3% and 1.0% among cases and 0.8% and 0.8% among controls). Among Kilifi general pediatric admissions, 3.9% (n = 274/6968) were PCR-positive, including 61.7% (n = 37/60) of those with positive blood cultures for pneumococcus. DISCUSSION. The utility of pneumococcal PCR on blood for diagnosing childhood pneumococcal pneumonia in the 7 low- and middle-income countries studied is limited by poor specificity and by poor sensitivity among MCPP cases.
