Comparison of Gram Stain and Latex Agglutination for Diagnosis of Meningococcal Meningitis

Coovadia, Y.M.; Ende, Jan van den; Solwa, Z

doi:10.1016/s0140-6736(89)90919-7

Cited by 10 publications

(7 citation statements)

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“…This is in accordance with studies showing Gram's stain to be more sensitive than BADT in diagnosing meningococcal meningitis. 6,7 Previous reports recommended that BADT be performed in patients who had previously received antibiotics. 4 We found it to have a positive predictive value of only 62.5% in these cases, compared to 100% for Gram's stain.…”

Section: Discussionmentioning

confidence: 99%

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CSF Bacterial Antigen Detection Testing in the Diagnosis of Meningitis

Narchi

1997

Ann Saudi Med

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Bacterial meningitis carries a high mortality and morbidity if untreated or treated late. The success of parenteral antibiotic therapy depends on early diagnosis. Although cerebral spinal fluid (CSF) studies allow early presumptive diagnosis prior to initiation of treatment, broad spectrum parenteral antibiotics are currently administered, regardless of initial CSF results, if a bacterial cause is suspected, with the inherent risk of drug side effects and induction of bacterial resistance. CSF culture allows bacteriological diagnosis, but results are not immediate. Rapid identification of the offending organism by Gram's stain characteristics or bacterial antigen detection testing (BADT) allows chemoprophylaxis of contacts whenever indicated.The value of these two tests in CSF analysis has been contradictory in the literature, especially in patients with meningitis who received antibiotic therapy before the lumbar puncture was carried out. [1][2][3][4][5][6][7][8][9][10] The clinical usefulness of these tests should, therefore, be reassessed in light of the local epidemiology, immunization programs (Haemophilus influenzae type b [Hib] and Neisseria meningitidis) and the cost containment imperatives that all health care systems are currently encountering.We undertook to assess the clinical usefulness of CSF BADT and Gram's stain studies in children diagnosed as having meningitis in our institution, focusing on the bacterial cases and on all those who had been treated with antibiotics prior to lumbar puncture. MethodsAll cases of meningitis diagnosed in children under 14 years of age in our institution between January 1983 and June 1995 were analyzed. Patients were considered to have bacterial meningitis if the clinical presentation was suggestive and if parenteral antibiotic therapy for bacterial meningitis was given for at least seven days, with either a positive CSF culture or BADT, or if organisms were seen on Gram's stain, or in the presence of meningococcal septicemia with purpura and CSF. pleocytosis in the absence of a positive CSF culture.All medical records were reviewed and data collected included age, sex, antibiotic therapy before lumbar puncture, results of CSF analysis (total white blood cells [WBC] and differential, protein, glucose, Gram's stain, culture and BADT). CSF pleocytosis was defined as CSF WBC over 6 x 10 -6 /L (6 WBC/mm 3 ). BADT was carried out with Wellcogen ® Bacterial Antigen Kit, Murex Diagnostics Limited, Dartford, England. This kit uses rapid qualitative latex agglutination technique to detect specific polysaccharide surface antigens for Haemophilus influenzae type b (Hib), Streptococcus pneumoniae (Strep. pneumoniae), Escherichia coli (E. coli) K1, group B streptococcus and Neisseria meningitidis (N meningitidis) groups A, B, C, Y and W135 antigens. ResultsDuring the study period, a total of 98 cases of meningitis were diagnosed: 63 were aseptic (64.3%) and 35 bacterial (35.7%). A total of 20 children (20.4%) had received antibiotics prior to diagnosis. Gram's stain showed org...

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Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10] The clinical usefulness of these tests should, therefore, be reassessed in light of the local epidemiology, immunization programs (Haemophilus influenzae type b [Hib] and Neisseria meningitidis) and the cost containment imperatives that all health care systems are currently encountering.…”

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confidence: 99%

CSF Bacterial Antigen Detection Testing in the Diagnosis of Meningitis

Narchi

1997

Ann Saudi Med

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“…Diagnosis is by detection of Gram-negative diplococcal bacteria or antigens in blood or cerebrospinal fluid (CSF) samples. Conventional methods are not specific and show low sensitivity, particularly in patients undergoing treatment (Ballard et al, 1987;Coovadia et al, 1989;Nato et al, 1991;Gray & Fedorko, 1992).…”

Section: Introductionmentioning

confidence: 99%

Direct-test PCR for detection of meningococcal DNA and its serogroup characterization: standardization and adaptation for use in a public health laboratory

Baethgen¹,

Moraes²,

Weidlich³

et al. 2003

Journal of Medical Microbiology

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A direct PCR test (DT-PCR) was established to detect Neisseria meningitidis DNA in clinical samples from patients with suspected bacterial meningitis. Specific primers for the 16S rDNA of N. meningitidis were designed to amplify a 600 bp DNA fragment. One hundred and ninety-three clinical samples were analysed, corresponding to 114 samples from patients diagnosed as positive and 79 as negative for infection by N. meningitidis using conventional methods (culture, latex agglutination and counterimmunoelectrophoresis). These samples were submitted to PCR by two different clinical sample preparation approaches (with and without DNA extraction and purification) and submitted to different PCR protocols to improve the results. In agarose gel detection, the sensitivity value for DT-PCR was 88·5 % and, using dot-blot DNA detection, the sensitivity increased to 96·4 %. The detection limit for meningococcus in cerebrospinal fluid was 2310 2 c.f.u. ml À1 .Serogroup prediction was done using a multiplex PCR protocol and the sensitivity was 83 % for agarose gel DNA detection and 96·4 % using dot-blot DNA detection.

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“…Le plus souvent, la culture n'est pas faite ou n'est pas interprétable. Les suspicions cliniques sont aussi renforcées par un examen macroscopique de l'aspect du liquide céphalorachidien (LCR), une microscopie après coloration de Gram, mais ce sont des examens peu spécifiques et peu sensibles [3,4,6,10]. On parlera alors de cas probables.…”

Section: Introductionunclassified

“…Toutefois, elle prend beaucoup de temps (12 à 24 heures) et exige une viabilité du germe. L'isolement de l'agent pathogène peut échouer, suite à l'administration d'une antibiothérapie préalable ou à une mauvaise conservation du LCR [4,6,10].…”

Section: Introductionunclassified

Efficacité d’une technique de réaction de polymérisation en chaîne (seminested et multiplex) pour l’identification des trois principales espèces bactériennes responsables de méningites au Burkina Faso

Nikièma

Toé²,

Adjami³

et al. 2009

Bull. Soc. Pathol. Exot.

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A prospective study (from August 2006 to April 2007) was carried out with 214 cerebrospinal fluid samples with suspicion of bacterial meningitis. The aim of the study was to assess the effectiveness of the simultaneous detection of Neisseria meningitidis, Streptococcus sp. and Haemophilus influenzae using seminested polymerase chain reaction strategy. Among the 214 samples tested by both PCR and culture, the overall confirmation rate was 64% for PCR and 40.1% for culture (P = 2 x 10⁻⁶). Taking culture method as the standard reference, the overall sensitivity of PCR was 98.8% and specificity, 59.4%. The sensitivity of PCR was 100, 97.3 and 100% respectively for N. meningitidis, Streptococcus sp. and H. influenzae with respective specificities of 70, 93.2 and 97.2%. In conclusion, the seminested PCR strategy is a sensitive method and it can be implemented in the reference public health laboratories for an exhaustive microbiological surveillance of bacterial meningitis.

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Comparison of Gram Stain and Latex Agglutination for Diagnosis of Meningococcal Meningitis

Cited by 10 publications

References 0 publications

CSF Bacterial Antigen Detection Testing in the Diagnosis of Meningitis

CSF Bacterial Antigen Detection Testing in the Diagnosis of Meningitis

Direct-test PCR for detection of meningococcal DNA and its serogroup characterization: standardization and adaptation for use in a public health laboratory

Efficacité d’une technique de réaction de polymérisation en chaîne (seminested et multiplex) pour l’identification des trois principales espèces bactériennes responsables de méningites au Burkina Faso

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