Clinical use of multiplex-PCR for the diagnosis of acute bacterial meningitis

Abstract

Background and Objectives: Prompt and accurate diagnosis of acute bacterial meningitis (ABM) is critical for patient management. We designed and evaluated two sets of multiplex-PCR assays for the simultaneous detection of six major etiologies of ABM i.e., Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis in one set and Listeria monocytogenes, Streptococcus agalactiae, and Escherichia coli in another set of multiplex-PCR in CSF of patients with suspected ABM. Methods: A total of 113 CSF specimens from patients of all ages having clinical features suggestive of meningitis were tested for bacteriological evidence by Gram’s smear, culture, and our designed multiplex-PCR. Results: Multiplex-PCR assay performed excellently by increasing the overall detection rate by 6% when compared to culture as of total 113 samples tested, 17 (15%) were positive by multiplex-PCR whereas only 9% (10/113) were positive by culture. It detected the DNA in eight culture negative samples revealing the presence of S. pneumoniae in three and other possible bacterial pathogens in five of them. Our assay showed a DNA detection limit of 1 pg/μL. Compared to CSF culture, the sensitivity and specificity of the multiplex-PCR were 90% and 92.2%, respectively. Conclusion: This study accentuates the importance of multiplex-PCR assay that is efficiently fast and reliable for the diagnosis of acute bacterial meningitis that can substantially improve the diagnosis in culture negative cases, especially in patients who were previously started on antimicrobial therapy.

Mania: An atypical presentation of probable Streptococcus agalactiae meningoencephalitis

“…Molecular detection assays increase diagnostic accuracy for bacterial infections in individuals who are receiving or have received broad spectrum antimicrobials that may decrease sensitivity of bacterial cultures [25] , [26] , [27] , [28] . Bacterial maningitis with normal CSF analysis has been previously reported [29] .…”

The Role of Serum Procalcitonin in The Diagnosis and Detection of The Outcome of Acute Bacterial Meningitis in Children

“…It is frequently challenging to distinguish between bacterial and nonbacterial aetiologies due to comparable clinical presentation. Procalcitonin level is a potentially sensitive measure of severe bacterial infections, including meningitis, numerous studies have shown that bacterial illnesses, such as meningitis, are associated with elevated serum PCT values (3,6) .…”

An Overview of Clinical Manifestations of Dermatological Disorders in Intensive Care Units: What Should Intensivists Be Aware of?

“…The definitive diagnosis is the presence of meningococci in the blood, CSF, throat swab, or skin biopsy from the rash. Furthermore, CSF analysis typically reveals high protein, low glucose, CSF with a glucose to blood glucose ratio of 0.4 or lower, high lactate, and high neutrophils [ 58 , 59 , 60 , 61 ]. Antimicrobials most commonly used to eradicate meningococci include penicillin, rifampin, ciprofloxacin, and ceftriaxone [ 62 , 63 , 64 ].…”