Dynamics of PCR-based diagnosis in patients with invasive meningococcal disease

Abstract

Invasive meningococcal disease continues to be a life-threatening condition and rapid diagnosis is important for the administration of appropriate treatment. This study focused on the use of PCR for the diagnosis of meningococcal aetiology and the dynamics of PCR-based diagnosis over time in various biological samples. Sixty cerebrospinal fluid (CSF) and 144 serum samples collected during the first week of hospitalisation from 37 patients with laboratory-confirmed invasive meningococcal disease were investigated. Overall, 91.9% of CSF samples and 45.9% of serum samples were PCR-positive, while culture of CSF and blood was positive for only 35% and 39% samples, respectively. Positive PCR results were obtained until day 7 with CSF and until day 5 with serum. It is therefore recommended that samples for molecular diagnosis should be collected early in the course of suspected invasive meningococcal disease.

Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis

“…A third study showed only 7 positive agglutination tests out of 478 CSF samples tested; all 7 patients had a CSF Gram stain showing the causative microorganism (253). A study of meningococcal meningitis patients showed a strong decline in the sensitivity of latex agglutination, from 60% for patients without antibiotic pretreatment prior to lumbar puncture to 9% for antibiotic-pretreated patients (43). The limited additional value of latex agglutination testing was also shown by several other studies, and its use is therefore limited (138,174,204,234,301).…”

“…Blood culture positivity differs for each causative organism: 50 to 90% of H. influenzae meningitis patients (233,246), 75% of pneumococcal meningitis patients (11,15,49,68,95,148,208,242,286,294,340), and 40% of children and 60% of adult patients with meningococcal meningitis (141,296). The yield of blood cultures was decreased by 20% for pretreated patients in two studies (43,235).…”

“…These tests utilize serum containing bacterial antibodies or commercially available antisera directed against the capsular polysaccharides of meningeal pathogens and have been recommended for patients with suspected bacterial meningitis with no bacteria seen upon CSF Gram staining and negative CSF cultures (311). The reported sensitivities of latex agglutination testing of CSF samples from patients with bacterial meningitis ranged from 78 to 100% for H. influenzae type b meningitis, 59 to 100% for pneumococcal meningitis, and 22 to 93% for meningococcal meningitis (43,131,138,234,253,345). However, in a 10-year retrospective study of 176 children with culture-negative meningitis who were pretreated with antibiotics before lumbar puncture, none had a positive CSF latex agglutination result (95% confidence interval, 0 to 2%) (234).…”

“…Pretreatment with antibiotics may decrease the sensitivity of PCR of CSF samples. In a prospective study including 28 patients with clinically defined meningococcal meningitis, PCR of meningococcal DNA was positive for 13 (81%) of 16 patients who were treated with antibiotics prior to lumbar puncture, compared to all 21 patients without pretreatment (43). PCR can also be a useful tool for the swift typing of meningococcal strains in an evolving epidemic (247,258).…”

Human Brain Damage Detection using PorA Marker

“…Taha [16] and Lewis & Clarke [17] detected sero groups of N. meningitidis by crgA and siaD gene sequence analysis, which was time consuming and complicated. Baethgen et al [18] and Bronska et al [19] used purified G-DNA of N. meningitidis for PCR. Fraisier et al [20] reported a multiple gene based multiplex PCR, which was complicated and expensive.…”