PEDIATRICS Vol. 78 No. 1 July 1986, pp. 1-9
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Use of Bacterial Antigen Detection in the Diagnosis of Pediatric Lower Respiratory Tract Infections

Bonnie W. Ramsey MD1, Edgar K. Marcuse MD1, Hjordis M. Foy MD, PhD1, Marion K. Cooney PhD1, Inez Allan RN, MA1, David Brewer MD1, and Arnold L. Smith MD1

1 From the Division of Ambulatory Pediatrics and Infectious Diseases, Children's Orthopedic Hospital and Medical Center, and the Departments of Pediatrics, Pathobiology, and Epidemiology, University of Washington Schools of Medicine, Public Health and Community Medicine, Seattle

Two immunochemical methods were used to identify Haemophilus influenzae and Streptococcus pneumoniae capsular antigens in the urine and serum of 162 children with acute lower respiratory tract infection. These methods were compared with standard bacterial blood culture. Viral and mycoplasma cultures of respiratory secretions were obtained simultaneously to determine the frequency of antigenuria at the time of nonbacterial acute lower respiratory tract infection. Urine from groups of well children and children with acute otitis media was tested for capsular antigens to determine the incidence of antigenuria. Antigenuria was found in 24% of children 2 months to 18 years of age with acute lower respiratory tract infection compared with a 2% incidence of bacteremia. Antigenuria was found in 4% of asymptomatic children and 16% of children with acute otitis media. One third of children with symptoms of acute lower respiratory tract infection and viral isolates from the oropharynx had bacterial antigenuria. The sixfold increase in frequency of bacterial antigenuria in children at the time of lower respiratory symptoms suggests that bacterial acute lower respiratory tract infection may be more common than identified by traditional culture techniques. Because bacterial antigen may come from other sites such as the middle ear, further studies are needed to determine the role of antigen detection in the diagnosis of pediatric acute lower respiratory tract infection.

Key Words: bacteria • capsular antigen • pneumonia • lower respiratory tract infection • virus

Submitted on July 30, 1985
Accepted on October 23, 1985




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