Early treatment with parenteral penicillin in meningococcal disease.

Cartwright, Keith; Reilly, Sheena; White, D.; Stuart, James M.

doi:10.1136/bmj.305.6846.143

Cited by 225 publications

(119 citation statements)

References 31 publications

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“…Con®rmation of the diagnosis can be made from CSF in almost 90% of patients [1], but it may be dif®cult to obtain a sample of CSF, particularly from young infants, and lumbar puncture is sometimes contraindicated because of raised intracranial pressure [2]. Meningococci can be cultured from blood in c. 50% of untreated patients [3], but pre-admission antibiotic treatment, which reduces mortality and is recommended by the Chief Medical Of®cers in the UK, reduces the chance of a positive blood culture to <5% [4]. Nevertheless, con®rmation of diagnosis remains essential for: (i) optimum treatment of the patient; (ii) informed counselling of contacts, particularly when clusters of suspected cases occur, e.g., in a school or university; and (iii) monitoring the ef®ciency of and need for immunisation.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a PCR-immunoassay technique for detection of Neisseria meningitidis in cerebrospinal fluid and peripheral blood

Seward

Towner

2000

Journal of Medical Microbiology

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Section: Introductionmentioning

confidence: 99%

Evaluation of a PCR-immunoassay technique for detection of Neisseria meningitidis in cerebrospinal fluid and peripheral blood

Seward

Towner

2000

Journal of Medical Microbiology

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“…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.…”

mentioning

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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“…Studies show a 50% positivity of blood cultures in patients with untreated meningococcal infection. This rate is reduced to only 5% in case of antibiotic therapy prior to admission (17). This was also found in the cases of meningococcal infection admitted to the Clinic of Infectious Diseases in the last 15 years (1994-2011) (n = 323) in which the antibiotic use prior to admission (39% of cases) resulted in a significant reduction of the proportion of CSF positive results from 82.1% to 56% (p < 0.001), positive direct examination from 64.6% to 43.2% (p < 0.001), positive CSF culture from 55.9% to 27.2% (p < 0.001), positive CSF latex-agglutination from 84.6% to 58.8% (p = 0.003), and positive blood culture from 14.7% to 3.5% (p < 0.01) (18) and also similar to those from the current study.…”

Section: Discussionmentioning

confidence: 93%

The efficiency of sodC gene / N. meningitidis detection in comparison with the classical methods for the diagnosis of meningococcal infection / Evaluarea eficienţei Real Time PCR TaqMan utilizând gena sodC / N. meningitidis în comparaţie cu metodele clasice utilizate în diagnosticul infecţiei meningococice

Nemescu¹,

Ursu²,

Dorobăț³

et al. 2015

Romanian Review of Laboratory Medicine

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Meningococcal infection requires a fast and accurate diagnostic method in order to correctly initiate the antibiotic therapy. The aim of our study was to assess the efficiency of Real Time PCR -Taq Man using sod C gene / N. meningitidis in comparison with the classical methods for the diagnosis of meningococcal infection - direct microscopy, cultivation, latex agglutination and blood culture. We have detected 24/44 (54.54%) patients with meningococcal infection. In both cases of patients with / without previous antibiotic therapy before admission, the AUC (area under curve) had the highest values for RT PCR in CSF and blood analysis. This sod C RT-PCR assay is a highly sensitive and specific method for detection of Neisseria meningitis and it would be useful to include this method like a multiplex in routine testing of patients with clinical meningococcal infection for other etiological agents also.

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Early treatment with parenteral penicillin in meningococcal disease.

Cited by 225 publications

References 31 publications

Evaluation of a PCR-immunoassay technique for detection of Neisseria meningitidis in cerebrospinal fluid and peripheral blood

Evaluation of a PCR-immunoassay technique for detection of Neisseria meningitidis in cerebrospinal fluid and peripheral blood

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

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