Detection and serogroup determination of neisseria meningitidis in CSF by polymerase chain reaction (PCR)

Porritt, Robert J.; Mercer, Joanne; Munro, Rosemary

doi:10.1080/003130200104565

Cited by 32 publications

(17 citation statements)

References 12 publications

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“…Retrospective laboratory studies of meningococcal PCR have demonstrated high sensitivities (89 to 91%) and specificities (91 to 100%) for both CSF and blood (5,24,26,27). However, there have been very few prospective studies in a clinical setting.…”

Section: Discussionmentioning

confidence: 99%

Prospective Study of a Real-Time PCR That Is Highly Sensitive, Specific, and Clinically Useful for Diagnosis of Meningococcal Disease in Children

Bryant

Zaia

et al. 2004

J Clin Microbiol

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Due to the early administration of antibiotics, meningococcal disease is increasingly difficult to diagnose by culturing. Laboratory studies have shown PCR to be sensitive and specific, but there have been few clinical studies. The objectives of this study were to determine the diagnostic accuracy and clinical usefulness of meningococcal PCR through a prospective comparison of real-time PCR, nested PCR, and standard culturing of blood and cerebrospinal fluid (CSF). The setting was a tertiary-care pediatric hospital in Australia, and the participans were 118 children admitted with possible septicemia or meningitis. The main outcome measuressensitivity, specificity, and positive and negative predictive values-were compared to a "gold standard " fulfilling clinical and laboratory criteria. For 24 cases of meningococcal disease diagnosed by the gold standard, culturing of blood or CSF was positive for 15 (63%), nested PCR was positive for 21 (88%), and real-time PCR was positive for 23 (96%). The sensitivity, specificity, and positive and negative predictive values of real-time PCR (the most sensitive test) for all specimens were, respectively, 96% (95% confidence interval, 79 to 99%), 100% (95% confidence interval, 96 to100%), 100% (95% confidence interval, 85 to 100%), and 99% (95% confidence interval, 94 to 100%). Of 54 patients with suspected meningococcal disease at admission, 23 had positive PCR results. Only one PCR specimen was positive in a patient thought unlikely to have meningococcal disease at admission. Blood PCR remained positive for 33% of patients tested at up to 72 h. Real-time PCR has high positive and negative predictive values in this clinical setting, with better confirmation of cases than nested PCR. Targeting patients for PCR based on admission criteria appears to be practical, and the test may remain useful for several days after the start of antibiotic administration.Meningococcal septicemia and meningitis are life-threatening diseases. Rapid, accurate diagnosis is essential for optimal management of patients and the provision of prompt prophylaxis to contacts. Confirmation of the diagnosis allows physicians to use narrow-spectrum antibiotics, limit the duration of treatment, and provide prognostic information. It also provides vital disease burden information, including data to inform vaccine policy.It is becoming increasingly difficult to confirm the diagnosis of meningococcal infection by conventional microscopy and culturing techniques (6). Blood cultures are positive in about 50% of untreated patients with clinically suspected meningococcal septicemia. This rate is reduced to 5% when antibiotics have been administered prior to admission; primary care practitioners are encouraged in this practice early for suspected cases (8,9,19). Cerebrospinal fluid (CSF) microscopy or culturing is positive in 80 to 90% of untreated cases of meningococcal meningitis, but this rate is also reduced by prior antibiotic administration. In addition, many patients do not undergo a lumbar puncture early in t...

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Section: Discussionmentioning

confidence: 99%

Prospective Study of a Real-Time PCR That Is Highly Sensitive, Specific, and Clinically Useful for Diagnosis of Meningococcal Disease in Children

Bryant

Zaia

et al. 2004

J Clin Microbiol

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“…A falta do diagnóstico etioló-gico preciso tem sido importante problema da Tabela 4 Fatores relacionados à cultura como critério diagnóstico da doença meningocócica. 16,17,18,19 . Podem aumentar a confirmação laboratorial em mais de 50,0% de amostras com cultura negativas 20 , ampliando a capacidade de identificação de amostras contaminadas ou com bactérias mortas devido às más condições de refrigeração e transporte.…”

Section: Discussionunclassified

Critério diagnóstico da doença meningocócica na Região Metropolitana de Campinas, São Paulo, Brasil

et al. 2004

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Foi estudado o critério de confirmação etiológica: cultura, clínico, teste do Látex e contraimunoeletroforese, exame bacterioscópico e clínico/epidemiológico dos 568 casos notificados de doença meningocócica na Região Metropolitana de Campinas, São Paulo, Brasil, de 1993 a 2002. Foram analisadas as variáveis: forma clínica, idade, sexo, local de moradia e internação, época do ano de ocorrência, letalidade e sorogrupo da Neisseria meningitidis. Confirmaram-se, pela cultura, 68,7% dos casos. A letalidade foi diferente de acordo com o critério de confirmação da doença. As formas clínicas: meningite sem meningococcemia (OR = 2,87; IC: 1,89-4,38) e a meningococcemia sem meningite (OR = 0,26; IC: 0,17-0,45) mostraram-se associadas com o critério cultura. Maior atenção à confirmação diagnóstica deve ser dada aos casos mais severos. A utilização do teste da reação em cadeia de polimerase pode ser útil para aumentar a capacidade da confirmação etiológica da doença meningocócica em casos de culturas negativas.

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“…The first report of meningococcal meningitis diagnosed by PCR in a patient with a culture-negative CSF was reported by Kristensen in 1991 11) . Currently several oligonucleotides primer targets are being used for the detection and serogrouping of meningococci (NM1, NM2, IS1106, ctrA, sia(syn)D, crgA), with excellent sensitivity (89-96.7%) and specificity (91-100%) [12][13][14][15][16][17] . In Great Britain the development of a national PCR-based service increased the number of laboratory confirmed cases of meningococcal disease by 35% 18) .…”

Section: Discussionmentioning

confidence: 99%

Laboratory‐Acquired Serogroup A Meningococcal Meningitis

Kessler

Stephens

Somani

2007

Journal of Occupational Health

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Detection and serogroup determination of neisseria meningitidis in CSF by polymerase chain reaction (PCR)

Cited by 32 publications

References 12 publications

Prospective Study of a Real-Time PCR That Is Highly Sensitive, Specific, and Clinically Useful for Diagnosis of Meningococcal Disease in Children

Prospective Study of a Real-Time PCR That Is Highly Sensitive, Specific, and Clinically Useful for Diagnosis of Meningococcal Disease in Children

Critério diagnóstico da doença meningocócica na Região Metropolitana de Campinas, São Paulo, Brasil

Laboratory‐Acquired Serogroup A Meningococcal Meningitis

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