Assessment of an Antibody-in-Lymphocyte Supernatant Assay for the Etiological Diagnosis of Pneumococcal Pneumonia in Children

New diagnostic tests for the etiology of childhood pneumonia are needed. We evaluated the antibody-in-lymphocyte supernatant (ALS) assay to detect immunoglobulin (Ig) G secretion from ex vivo peripheral blood mononuclear cell (PBMC) culture, as a potential diagnostic test for pneumococcal pneumonia. We enrolled 348 children with pneumonia admitted to Patan Hospital, Kathmandu, Nepal between December 2015 and September 2016. PBMCs sampled from participants were incubated for 48 h before harvesting of cell culture supernatant (ALS). We used a fluorescence-based multiplexed immunoassay to measure the concentration of IgG in ALS against five conserved pneumococcal protein antigens. Of children with pneumonia, 68 had a confirmed etiological diagnosis: 12 children had pneumococcal pneumonia (defined as blood or pleural fluid culture-confirmed; or plasma CRP concentration ≥60 mg/l and nasopharyngeal carriage of serotype 1 pneumococci), and 56 children had non-pneumococcal pneumonia. Children with non-pneumococcal pneumonia had either a bacterial pathogen isolated from blood (six children); or C-reactive protein <60 mg/l, absence of radiographic consolidation and detection of a pathogenic virus by multiplex PCR (respiratory syncytial virus, influenza viruses, or parainfluenza viruses; 23 children). Concentrations of ALS IgG to all five pneumococcal proteins were significantly higher in children with pneumococcal pneumonia than in children with non-pneumococcal pneumonia. The concentration of IgG in ALS to the best-performing antigen discriminated between children with pneumococcal and non-pneumococcal pneumonia with a sensitivity of 1.0 (95% CI 0.73-1.0), specificity of 0.66 (95% CI 0.52-0.78) and area under the receiver-operating characteristic curve (AUROCC) 0.85 (95% CI 0.75-0.94). Children with pneumococcal pneumonia were older than children with non-pneumococcal pneumonia (median 5.6 and 2.0 years, respectively, p < 0.001). When the analysis was limited to children ≥2 years of age, assay of IgG ALS to pneumococcal proteins was unable to discriminate between children with pneumococcal pneumonia and non-pneumococcal pneumonia (AUROCC 0.67, 95% CI 0.47-0.88). This method detected spontaneous secretion of IgG to pneumococcal protein antigens from cultured PBMCs. However, when stratified by age group, assay of IgG in ALS to pneumococcal proteins showed limited utility as a test to discriminate between pneumococcal and non-pneumococcal pneumonia in children.

Pattern of Ophthalmological Diseases in the Patients of Shree Birendra Hospital

Introduction: Blindness is one of the most tragic yet often avoidable disabilities in the developing world. The pattern of ocular diseases varies in different parts of Nepal due to differences in socioeconomic and geographic factors. This retrospective study likely reflects the pattern of ocular diseases in Kathmandu Valley. Aim: To assess the patterns of ocular disease in the patients attending the outpatient department of Ophthalmology from 14th April 2009 to 13th April 2010 at the Army Hospital. Methods: This is a retrospective study and all the new cases which attended the department of Ophthalmology of Shree Birendra Hospital in the year 2066 were included. The diseases were divided into 11 groups i.e. lid & adenexal disorder, disease of conjunctiva & sclera, corneal diseases, lens associated disorders, diseases of uveal tract, refractive error, glaucoma & its associations, posterior segment diseases, ocular & systemic neoplastic disorders, Nekebadi (annual medical check up) and others. Result: The total number of patients recorded in the department of Ophthalmology is 16709. Among them 4473 were regular serving army personnel and 12236 were ex-army and army families. Conclusion: The pattern of eye disease varies in different age groups. In younger age group conjunctival, scleral disease and refractive error were commonly seen whereas in elder age group lens disorder was frequently seen. The number of blind patients was more in females than in male patients. Key words: Conjunctivitis; Cataract; Blindness. DOI: http://dx.doi.org/10.3126/mjsbh.v9i2.5023 Medical Journal of Shree Birendra Hospital Vol.9(2) 2010: 30-37