Comparison of Bacterial Antigen Test and Gram Stain for Detecting Classic Meningitis Bacteria in Cerebrospinal Fluid

Karre, Tess; Vetter, Emily A.; Mandrekar, Jayawant N.; Patel, Robin

doi:10.1128/jcm.00153-10

Cited by 13 publications

(8 citation statements)

References 14 publications

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“…61 Several rapid antigen-based assays for bacterial meningitis were introduced at the turn of this century but have had disappointing performance. 64,65 With the advent of molecular techniques, this approach has largely fallen out of favor.…”

Section: Direct Detection Of Pathogen or Antigenmentioning

confidence: 99%

Diagnostic Testing in Central Nervous System Infection

2019

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Several key points should guide providers managing a patient with suspected CNS infection. The first is the importance of developing a plan for the diagnostic workup. Clinicians are recommended to first test for the most likely and Keywords ► meningitis ► encephalitis ► diagnostic ► metagenomic sequencing AbstractPatients with central nervous system (CNS) infection experience very high levels of morbidity and mortality, in part because of the many challenges inherent to the diagnosis of CNS infection and identification of a causative pathogen. The clinical presentation of CNS infection is nonspecific, so clinicians must often order and interpret many diagnostic tests in parallel. This can be a daunting task given the large number of potential pathogens and the availability of different testing modalities. Here, we review traditional diagnostic techniques including Gram stain and culture, serology, and polymerase chain reaction (PCR). We highlight which of these are recommended for the pathogens most commonly tested among U.S. patients with suspected CNS infection. Finally, we describe the newer broadrange diagnostic approaches, multiplex PCR and metagenomic sequencing, which are increasingly used in clinical practice.This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.• What pathogen is being interrogated;• How to test for it (e.g., serology vs. PCR);• Where to look (e.g., CSF vs. blood);• When to test (e.g., need for paired acute/convalescent sera).Another important consideration is the turnaround time between ordering a test and receiving its results, since clinical decisions often need to be made empirically while awaiting test results. In general, PCR tests are rapid and often available in-house, while specialized serology tests may only be available at reference laboratories. However, there is substantial variation between clinical microbiology laboratories, so close communication with laboratory personnel is essential. Detection of Immune Response by SerologySerological tests are widely used in the diagnosis of CNS infections, particularly for pathogens present at low levels or for brief periods of time, and for diseases whose manifestations are primarily mediated by the host antibody response.

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Section: Direct Detection Of Pathogen or Antigenmentioning

confidence: 99%

Diagnostic Testing in Central Nervous System Infection

2019

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“…With the advent of vaccines to H. influenza type b and N. meningitides (A, C, Y, and W-135) the antigen testing is even less useful. The literature confirms that the use of direct antigen testing from the CSF is neither sensitive nor specific [49,50]. More importantly, the Gram stain and cultures still need to be performed regardless of the initial antigen test result.…”

Section: Bacterial Antigen Detectionmentioning

confidence: 97%

“…The test's purported advantages were the rapid detection of H. influenza, N. meningitides, S. pneumoniae, and S. agalactiae. Overall, the sensitivity is essentially the same as that of a Gram-stained smear of a cyto-centrifuged CSF specimen [49,50]. With the advent of vaccines to H. influenza type b and N. meningitides (A, C, Y, and W-135) the antigen testing is even less useful.…”

Section: Bacterial Antigen Detectionmentioning

confidence: 99%

Establishing benchmarks and metrics for disruptive technologies, inappropriate and obsolete tests in the clinical laboratory

Kiechle

Arcenas

Rogers

2014

Clinica Chimica Acta

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Benchmarks and metrics related to laboratory test utilization are based on evidence-based medical literature that may suffer from a positive publication bias. Guidelines are only as good as the data reviewed to create them. Disruptive technologies require time for appropriate use to be established before utilization review will be meaningful. Metrics include monitoring the use of obsolete tests and the inappropriate use of lab tests. Test utilization by clients in a hospital outreach program can be used to monitor the impact of new clients on lab workload. A multi-disciplinary laboratory utilization committee is the most effective tool for modifying bad habits, and reviewing and approving new tests for the lab formulary or by sending them out to a reference lab.

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“…However, this method suffers from both poor sensitivity and poor specificity (3,4). Cytospin-concentrated Gram stains of CSF can increase Gram stain sensitivity.…”

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confidence: 99%

“…With the use of CSF supplemented with known amounts of bacteria, it has been demonstrated that cytospin Gram stains can increase bacterial detection by up to 2 logs compared to the level for Gram stains performed on specimens that have not been cytospin concentrated or concentrated using a conventional centrifuge (5). The use of latex agglutination is now discouraged due to its lack of utility, and presently, the cytospin Gram stain appears to be the most sensitive way to detect bacterial agents causing meningitis prior to culture results (3,6).…”

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confidence: 99%

Answer to November 2014 Photo Quiz

Pence¹

2014

J Clin Microbiol

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Comparison of Bacterial Antigen Test and Gram Stain for Detecting Classic Meningitis Bacteria in Cerebrospinal Fluid

Cited by 13 publications

References 14 publications

Diagnostic Testing in Central Nervous System Infection

Diagnostic Testing in Central Nervous System Infection

Establishing benchmarks and metrics for disruptive technologies, inappropriate and obsolete tests in the clinical laboratory

Answer to November 2014 Photo Quiz

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