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Bedside Leukocyte Esterase Testing to aid in Diagnosing Bacterial Conjunctivitis in Children
Linda Solomon1, Sandra J Cunningham1
1Department of Pediatrics, Division of Pediatric Emergency Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, New York.
Insights
The leukocyte esterase (LE) test strip showed low specificity in diagnosing bacterial conjunctivitis in children. This test has limited ability to differentiate bacterial infections from other causes of conjunctivitis.
Area of Science:
- Pediatric Emergency Medicine
- Ophthalmology
- Clinical Diagnostics
Background:
- Conjunctivitis is a common pediatric emergency department presentation.
- Differentiating the etiology of conjunctivitis clinically is challenging.
Purpose of the Study:
- To assess the diagnostic performance of leukocyte esterase (LE) test strips for bacterial conjunctivitis in pediatric patients.
Main Methods:
- Prospective enrollment of 189 patients (3 months–21 years) with conjunctivitis symptoms.
- Comparison of LE test strip results with eye culture findings.
- Evaluation of test performance characteristics including sensitivity and specificity.
Main Results:
- 62% of eye cultures were positive for bacterial infection.
- LE test strips demonstrated high sensitivity (96%) but low specificity (14%).
- Positive and negative predictive values were 64% and 67%, respectively.
Conclusions:
- The LE test strip has a limited role in accurately diagnosing bacterial conjunctivitis in pediatric patients.
- Further diagnostic methods are needed to differentiate bacterial causes from other etiologies.
Background:
Conjunctivitis is a frequent symptom in pediatric emergency departments; however, the etiology of conjunctivitis is difficult to clinically differentiate.
Objective:
Our study objective was to evaluate the test performance characteristics of leukocyte esterase (LE) test strips in diagnosing bacterial conjunctivitis.
Methods:
Patients aged from 3 months through 21 years presenting to an emergency department with symptoms of conjunctivitis were prospectively enrolled from September 2018 to March 2020. A swab of the affected eye was applied to the LE test strip and another swab was sent for culture processing. The primary outcome was the association between LE test results and eye culture results.
Results:
We enrolled 189 patients. Overall, 117 eye cultures (62%) were positive. The sensitivity and specificity of LE testing was 96% (95% CI 90-98%) and 14% (95% CI 7-25%), respectively. Positive predictive value was 64% (95% CI 57-71%) and negative predictive value was 67% (95% CI 39-87%).
Conclusions:
The LE test strip had limited ability to differentiate bacterial conjunctivitis from other etiologies.
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