Correlation of circulating capsular polysaccharide with bacteremia in pneumococcal pneumonia

Immunoelectroosmophoresis with rabbit anticapsular antibody was used to detect type-specific pneumococcal polysaccharide in serum from bacteremic patients with pneumococcal pneumonia. The test could detect as little as 0.1 to 1.0 mug per ml or 0.2 to 2 ng per test of polysaccharide from types 1, 2, 3, 4, 5, 8, 12, and 18, and its sensitivity was 10 times that of double immunodiffusion. Although antigen could be detected by double immunodiffusion with types 7 and 14, no antigen could be detected by immunoelectroosmophoresis. Types 7 and 14 polysaccharides were found to be positively charged, whereas the other polysaccharides were negatively charged. Forty-six patients with pneumonia were selected for study because pneumococci corresponding to those types where the test was known to work had been isolated from blood or the respiratory tract. Antigenemia correlated strongly with bacteremia: 12 of 20 bacteremic patients with pneumonia showed antigenemia, whereas 26 patients negative for bacteremia did not show circulating antigen detectable with antisera against the pneumococcal type isolated from the respiratory tract. The apparent concentration of circulating polysaccharide ranged from 0.1 to 100 mug per ml of serum, and the concentration did not appear to diminish appreciably in 10 to 15 days. Three of 12 patients with antigenemia died, and two of these had the highest levels of circulating antigen observed.