Laboratory-based diagnosis of pneumococcal pneumonia: state of the art and unmet needs
Laboratory-based diagnosis of pneumococcal pneumonia: state of the art and unmet needs
复制标题
DOI：
10.1111/j.1469-0691.2011.03496.x
复制
发表时间：
2011-05-01
影响因子：
14.2
通讯作者：
Klugman, K. P.
中科院分区：
文献类型：
--
作者：
Vernet, G.;Saha, S.;Klugman, K. P.
鉴于肺炎球菌疫苗的使用越来越多，特别是在发展中国家，需要进行适当的诊断，以了解肺炎的病因，确定肺炎球菌疾病的负担，并监测疫苗的效力和有效性。本文总结了由PATH和梅里埃基金会组织的关于肺炎球菌疾病的诊断、检测和血清分型的会议（2009年10月18日至20日，梅里埃基金会会议中心，Les Pensieres，法国）。工作人员和专家开会讨论了基于微生物的肺炎链球菌疾病诊断的差距，特别强调了肺炎。会议旨在评价肺炎球菌诊断和血清分型方法的最新发展水平，确定研究和开发需求，并向公共卫生当局提出新的指导方针，以支持疫苗的引进。关于检测，主要建议是鼓励进行胸部X光检查和尿液抗原检测。需要进行大规模的研究来评估将胸部X光、尿液抗原检测、沙门氏菌检测和其他检测方法相结合的检测算法的诊断效用。鼻咽抽吸物和痰中的肺炎克雷伯氏菌定量PCR，以及血液中的C反应蛋白或降钙素原测量。应集中精力于蛋白质组学，以确定肺炎期间表达的尿液中的肺炎球菌特异性抗原或血液中的宿主标志物。建议开发S.肺炎分型能力，了解肺炎球菌疾病的流行病学，并评估疫苗的有效性。鼓励采用简单有效的方法，并应开发基于微珠、微阵列或深度测序的新技术，以在单一测试荚膜血清型中确定耐药谱和基因型。
In view of the increasing use of pneumococcal vaccines, especially in the developing world, there is a need for appropriate diagnostics to understand the aetiology of pneumonia, to define the burden of pneumococcal disease, and to monitor vaccine efficacy and effectiveness. This article summarizes a meeting on the diagnosis, detection and serotyping of pneumococcal disease organized by PATH and Fondation Merieux (18-20 October 2009, Fondation Merieux Conference Centre, Les Pensieres, France). Workers and experts met to discuss the gaps in the microbiology-based diagnosis of Streptococcus pneumoniae disease, with special emphasis on pneumonia. The meeting was designed to evaluate the state of the art of pneumococcal diagnostics and serotyping methodologies, identify research and development needs, and propose new guidelines to public health authorities to support the introduction of vaccines. Regarding detection, the main recommendations were to encourage chest X-rays and antigen detection in urine. Large-scale studies are needed to evaluate the diagnostic utility of test algorithms that associate chest X-rays, antigen detection in urine, S. pneumoniae quantitative PCR in nasopharyngeal aspirates and sputum, and C-reactive protein or procalcitonin measurement in blood. Efforts should be focused on proteomics to identify pneumococcus-specific antigens in urine or host markers in blood expressed during pneumonia. It was recommended to develop S. pneumonioe typing capacities, to understand the epidemiology of pneumococcal disease, and to evaluate vaccine effectiveness. Simple and effective approaches are encouraged, and new technologies based on beads, microarrays or deep sequencing should be developed to determine, in a single test capsular serotype, resistance profile and genotype.