Ndirect Specific Means to Detect Pneumococcal Involvement

Some investigators have used indirect means to demonstrate the involvement of the pneumococcus in infection, either by measuring free or complexed antibodies directed against pneumococcal structures such as capsular or C-polysaccharides, or proteins such pneumolysin (Lankinen et al., 1999) or PsaA (Scott A et al., 2005). These methods increase the diagnostic yield, however, one serum sample is not enough; paired samples with a minimum interval of 7 to 10 days are required to detect a rising level, thus making the method very inconvenient for immediate clinical diagnostics, and better suited for epidemiological studies. Furthermore, the interpretation of serological tests is far from clear-cut. It is not well understood how

Figure 12.1 Carriage acquisition in different countries. Cumulative prevalence of pneumococcal NP colonization by age in various populations. Numbers in parentheses, references. *, Israeli Bedouins; **, Israeli Jews (R Dagan, unpublished data). Reference 5 is from India, 6 from Papua New Guinea, 7 from the United States, 8 from Australia (Aboriginal site), 9 from Costa Rica, 10 from United States, 11 from Sweden and 12 from Finland (O'Brien et al., 2003).

Figure 12.1 Carriage acquisition in different countries. Cumulative prevalence of pneumococcal NP colonization by age in various populations. Numbers in parentheses, references. *, Israeli Bedouins; **, Israeli Jews (R Dagan, unpublished data). Reference 5 is from India, 6 from Papua New Guinea, 7 from the United States, 8 from Australia (Aboriginal site), 9 from Costa Rica, 10 from United States, 11 from Sweden and 12 from Finland (O'Brien et al., 2003).

often bacterial carriage acquisition per se significantly elicits antibodies and whether the change in concentration can be differentiated from that following invasive disease.

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