Enhanced Diagnosis of Pneumococcal Meningitis with Use of the Binax NOW Immunochromatographic Test of Streptococcus pneumoniae Antigen: A Multisite Study

Background. Accurate etiological diagnosis of meningitis in developing countries is needed, to improve clinical care and to optimize disease-prevention strategies. Cerebrospinal fluid (CSF) culture and latex agglutination testing are currently the standard diagnostic methods but lack sensitivity. Methods. We prospectively assessed the utility of an immunochromatographic test (ICT) of pneumococcal antigen (NOW Streptococcus pneumoniae Antigen Test; Binax), compared with culture, in 5 countries that are conducting bacterial meningitis surveillance in Africa and Asia. Most CSF samples were collected from patients aged 1–59 months. Results. A total of 1173 CSF samples from suspected meningitis cases were included. The ICT results were positive for 68 (99%) of the 69 culture-confirmed pneumococcal meningitis cases and negative for 124 (99%) of 125 culture-confirmed bacterial meningitis cases caused by other pathogens. By use of culture and latex agglutination testing alone, pneumococci were detected in samples from 7.4 % of patients in Asia and 15.6 % in Africa. The ICT increased pneumococcal detection, resulting in similar identification rates across sites, ranging from 16.2 % in Nigeria to 20 % in Bangladesh. ICT detection in specimens from culture-negative cases varied according to region (8.5 % in Africa vs. 18.8 % in Asia;), prior antibiotic use (24.2 % with prior antibiotic use vs. 12.2 % without;P!.001), and WBC count (9.0 % for WBC count of 10–99 cells/mL, 22.1 % for 100–999 cells/mL, and 25.4 % forP!.001 1000 cells/mL; by test for trend).P!.00