Journal
CLINICAL MICROBIOLOGY AND INFECTION
Volume 20, Issue 12, Pages O1145-O1151Publisher
WILEY-BLACKWELL
DOI: 10.1111/1469-0691.12752
Keywords
Carriage; culture; density; qPCR; Streptococcus pneumoniae
Categories
Funding
- Royal Liverpool Hospital NHS Trust
- Broadgreen University Hospital NHS Trust
- Liverpool School of Tropical Medicine
- Bill and Melinda Gates Foundation [OPP1035281]
- National Institutes for Health Research Comprehensive Local Research Network
- EU-FP7 (ENIAC Joint Undertaking-CAJAL4EU)
- Bill and Melinda Gates Foundation [OPP1035281] Funding Source: Bill and Melinda Gates Foundation
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The density and duration of pneumococcal carriage are considered to affect the likelihood of transmission and invasive disease. Because of its importance in both spreading and causing disease, carriage has been suggested as an endpoint in future vaccine studies. Culture is the current gold standard for detection, but may not be sensitive enough to detect changes at low density. Healthy adult volunteers received an intranasal inoculation of Streptococcus pneumoniae serotype6B. Pneumococcal density in nasal washes collected at six time-points post-inoculation was determined by culture and quantitative PCR (qPCR). Natural pneumococcal carriers detected at initial screening were followed in parallel. In 331 nasal washes from 79 volunteers, the sensitivity and specificity of pneumococcal detection by qPCR, as compared with culture, were 92.3% and 75.9%. The estimation of pneumococcal density by culture and qPCR was highly correlated (r(s)=0.73, p<0.0001), although qPCR had a lower detection limit. Pneumococcal density fluctuated within a carriage episode, and occasionally fell below the detection limit of both methods. The duration of carriage episodes was underestimated when only one method was used. Similar fluctuations in density were observed in natural carriers. Pneumococcal carriage is a dynamic event. Culture and qPCR are complementary for surveying the density and duration of pneumococcal carriage episodes.
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