P-fimbriae of pyelonephritogenic Escherichia coli: detection in clinical material by a rapid receptor-specific agglutination test.

A slide agglutination test to detect P-fimbriated Escherichia coli was developed by attaching glycosides containing the relevant receptor structure (alpha-D-Galp-(1-4)-beta-D-Galp) to particles. A suspension of these particles agglutinates within ten seconds when mixed with P-fimbriated bacteria. The test is named the P-specific particle agglutination test (PPA test). The PPA test is more sensitive than the haemagglutination assays previously used. The exclusive specificity of the PPA test also allows the detection of P-fimbriae on strains which additionally possess other fimbriae (e.g. X-fimbriae). Using this test, the frequency of P-fimbriated E. coli in children with acute non-obstructive pyelonephritis was shown to exceed 95%. In lower urinary tract infections the frequency of P-fimbriated E. coli was approximately 20%. Moreover, children with acute pyelonephritis were also found to be heavily colonized in both the periurethral area and the intestine with the identical P-fimbriated E. coli strain.