Pneumococcal Disease Tests

What are pneumococcal disease tests?

Pneumococcal disease is the name for any infection caused by pneumococcus bacteria (Streptococcus pneumoniae). Pneumococcal disease tests look for these bacteria in your:

• Blood
• Urine
• Sputum, the thick mucus coughed up from your lungs
• Cerebrospinal fluid (CSF), the fluid in spaces around your brain and spinal cord

Your health care provider will decide which type of test you need, based on your symptoms.

You may have one or more of these pneumococcal disease tests, depending on where in your body you have an infection:

• A pneumococcal PCR test, which is a test that checks for small amounts of the genetic material of pneumococcus bacteria in a sample of your blood.
• A pneumococcal antigen test, which is used to identify pneumococcus bacteria in your urine or cerebrospinal fluid.
• A pneumococcal culture, which is a bacteria culture test that helps find pneumococcus bacteria in a sample of your blood, urine, sputum, or other tissue.

Pneumococcal disease often causes a fever. Which other symptoms you have and how serious they are can vary, depending on where your infection is.

If your infection is mild, the infection may be considered "noninvasive" (an infection that doesn't spread to your major organs or blood). If you have a noninvasive infection, the bacteria may cause:

• An ear infection
• A sinus infection

You may have more serious symptoms if the infection is considered "invasive" (an infection that can or has spread to other parts of your body). If you have an invasive infection, the bacteria may get into your:

• Lungs, which could lead to pneumonia
• Bloodstream, which is called bacteremia and can lead to sepsis
• Tissue surrounding your brain and spinal cord, which could lead to meningitis

Pneumococcal bacteria can spread from person to person through droplets from infected saliva (spit) or mucus. For example, this can happen when:

• Someone who has the bacteria coughs or sneezes near you
• You touch an item that has infected droplets on it
• You kiss someone who has the bacteria

Many people, especially children, have this bacteria in their nose or throat at one time or another. Most of the time, they don't get sick, and this is called being a "carrier" of the bacteria. But they can still spread it to others.

Pneumococcal disease often spreads through crowded settings and is more common during winter and early spring.

Anyone can get pneumococcal disease, but some people have a higher risk. They include people who:

• Are age 65 or older. Older adults tend to have more severe symptoms and complications.
• Are younger than five years old.
• Live in a long-term care facility.
• Are current or former smokers.
• Have a chronic (long-lasting) lung disease such as COPD or emphysema.
• Have a weakened immune system due to a disease such as HIV or because you are taking certain medicines such as corticosteroids or chemotherapy.
• Have a chronic health condition such as diabetes, coronary artery disease, or kidney failure.
• Have alcohol use disorder (AUD).
• Have no spleen.
• Have a cochlear implant (an implanted device that helps you hear).
• Are from certain racial and ethnic groups, such as Alaska Native people, African American people, and certain American Indian people.

Other names: Streptococcus pneumoniae test, S. pneumoniae test, Pneumococcal Culture, Pneumococcal Antigen Test, Pneumococcal PCR Test

What is it used for?

Pneumococcal disease tests are used to find out whether you have pneumococcal disease.

Why do I need a pneumococcal disease test?

Symptoms of pneumococcal infections can vary, depending on which part of your body is affected. They most often affect your lungs, middle ear, or sinuses. Your symptoms could begin suddenly. They can range from mild to severe. It's important to get the right diagnosis and treatment to help prevent health complications.

Symptoms of an ear infection can include:

• A red, swollen eardrum
• Ear pain
• Fever
• Fluid draining from the ear

Symptoms of a sinus infection can include:

• Cough
• Facial pain or pressure
• Headache
• Post-nasal drip (mucus dripping down the throat)
• Runny or stuffy nose
• Sore throat

Symptoms of pneumococcal pneumonia, a lung infection, can include:

• Sharp chest pain, often on one side
• Cough
• Fever and chills
• Rapid or difficulty breathing
• In older adults, confusion or not being alert

Symptoms of pneumococcal bacteremia, a bloodstream infection, can include:

• Chills
• Fever
• Confusion

Symptoms of pneumococcal meningitis, an infection of the lining of your brain and spinal cord, can include:

• Confusion
• Fever
• Headache
• Your eyes being more sensitive to light (photophobia)
• A stiff neck, which may make lowering your chin to your chest difficult
• In babies, not eating or drinking as well, being less alert, and sometimes vomiting

Call your provider if you think that you or your child could have a serious pneumococcal infection. Severe infections can lead to sepsis or long-term health problems.

What happens during a pneumococcal disease test?

The type of pneumococcal disease test you have is usually based on your symptoms. If you have a mild infection, such as an ear or sinus infection, your provider may diagnose and treat you based on your symptoms, medical history, and a physical exam.

Depending on your symptoms, your provider may want a sample of certain body fluids. They may want one or more samples, which could be from your:

• Blood
• Urine
• Sputum
• Nostrils (nasopharyngeal swab)
• Cerebrospinal fluid (CSF)

Your provider may order a pneumococcal culture, pneumococcal antigen test, and/or a pneumococcal PCR test to help identify the bacteria.

Your sample may be tested using a Gram Stain and/or bacterial culture which involves growing bacteria in your sample to help identify what type is causing your infection. Knowing the cause may help your provider figure out which antibiotic will work best, since some pneumococcal bacteria may have become resistant to certain antibiotics.

During a blood test:

If your provider thinks you might have meningitis or a bloodstream infection, they may collect a blood sample for a pneumococcal PCR test.

A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

During a clean catch urine test:

If your provider suspects that you might have pneumonia, they may want a urine sample for a pneumococcal antigen test, which is often used to test for the pneumococcal bacteria.

You will need to give a urine sample for the test. A health care professional may give you a cleansing wipe, a small container, and instructions for how to use the "clean catch" method to collect your urine sample. It's important to follow these instructions so that germs from your skin don't get into the sample:

1. Wash your hands with soap and water and dry them.
2. Open the container without touching the inside.
3. Clean your genital area with the cleansing wipe:
   • For a penis, wipe the entire head (end) of the penis. If you have a foreskin, pull it back first.
   • For a vagina, separate the labia (the folds of skin around the vagina) and wipe the inner sides from front to back.
4. Urinate into the toilet for a few seconds and then stop the flow. Start urinating again, this time into the container. Don't let the container touch your body.
5. Collect at least an ounce or two of urine into the container. The container should have markings to show how much urine is needed.
6. Finish urinating into the toilet.
7. Put the cap on the container and return it as instructed.

If you have hemorrhoids that bleed or are having your menstrual period, tell your provider before your test.

During a sputum test:

Your provider may request a sputum sample for a pneumococcal culture. Sputum is a thick type of mucus made in your lungs. If you have an infection or chronic illness affecting your lungs or airways, sputum can settle in your lungs, and you can also cough it up. During the sputum test:

• You may be asked to rinse your mouth with water before the sample is taken.
• Your provider will ask you to breathe deeply and then cough deeply into a special cup.
• Your provider may tap you on the chest to help loosen sputum from your lungs.
• If you have trouble coughing up enough sputum, your provider may ask you to breathe in a salty mist to help you cough more deeply.

During a nasal swab test:

Your provider may want to do a pneumococcal culture with a sample of cells from inside your nostrils or from the nasopharynx, the uppermost part of your nose and throat.

During a nasopharyngeal (NP) swab:

• You will tilt your head back.
• Your provider will insert a long swab into your nostril until it reaches your nasopharynx (the upper part of your throat).
• Your provider will rotate the swab for 10 to 15 seconds and remove it.

If your provider gets enough of a sample from one of your nostrils, they may only need to do one. But they may need to get a sample from your other nostril as well if they had trouble getting the sample from the first side.

During a spinal tap:

If your provider thinks you might have meningitis or a bloodstream infection, they may collect a sample of your cerebrospinal fluid for a pneumococcal antigen test.

To get a sample of cerebrospinal fluid, a provider will do a procedure called a spinal tap, also known as a lumbar puncture. A spinal tap is usually done in a hospital. During the procedure:

• You will lie on your side or sit on an exam table.
• A provider will clean your back and inject an anesthetic into your skin, so you won't feel pain during the procedure. Your provider may put a numbing cream on your back before this injection.
• When the area on your back is completely numb, your provider will insert a thin, hollow needle between two vertebrae in your lower spine. Vertebrae are the small backbones that make up your spine.
• Your provider will withdraw a small amount of cerebrospinal fluid for testing. This will take about five minutes.
• You'll need to stay very still while the fluid is being withdrawn.
• Your provider may ask you to lie on your back for an hour or two after the procedure. This may prevent you from getting a headache afterward.

Will I need to do anything to prepare for this test?

For most pneumococcal disease tests, you don't need any special preparation. Talk to your provider and ask about any special preparations. You may need to fast (not eat or drink) before the test. You may also need to stop taking certain medicines, so be sure to tell your provider about everything you take. But don't stop taking any medicines unless your provider tells you to.

Are there any risks to this test?

There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.

There is no risk to providing a urine or sputum sample.

A nasopharyngeal swab may be uncomfortable and cause coughing or gagging. All these effects are temporary.

With a spinal tap, there is very little risk. You may feel a little pinch or pressure when the needle is inserted. After the test, you feel some pain or tenderness in your back, or have some bleeding where the needle was inserted. You may also get a headache. The headache may last for several hours or up to a week or more, but your provider may suggest treatment to relieve the pain.

What do the results mean?

The results will show whether you have pneumococcal disease.

• A positive result means that pneumococcus bacteria were found in your specimen. You most likely have pneumococcal disease.
• A negative result means that no pneumococcus bacteria were found in your specimen. Most likely, your symptoms are not caused by pneumococcal disease.

If you have questions about your results, talk to your provider. They will consider your symptoms and medical history to understand the results of your pneumococcal disease test. They may also want to use a physical exam and/or other tests to help them make a diagnosis and decide on the best treatment for you. These other tests could include:

• Chest x-ray
• Complete blood count (CBC) and differential
• Erythrocyte sedimentation rate (ESR)
• C-reactive protein (CRP) test

Learn more about laboratory tests, reference ranges, and understanding results.

Is there anything else I need to know about a pneumococcal disease test?

Pneumococcal disease may be treated with antibiotics, fluids, pain relievers, and rest. But don't give aspirin to children, because it may cause Reye syndrome. This is a rare, serious illness that can affect the brain and liver.

There are two types of vaccines to help prevent pneumococcal disease. Vaccines can reduce the risk of infection, especially for children younger than five years old, adults 65 years or older, and people with health conditions that increase their risk for the disease. Ask your provider if they recommend that you or your child get a vaccine.