Increasing microbiological confirmation and changing epidemiology of meningococcal disease on Merseyside, England

Carrol, Enitan D.; Thomson, A. P. J.; Riordan, F. A. I.; Fellick, J M; Shears, P.; Sills, J. A.

doi:10.1046/j.1469-0691.2000.00078.x

Cited by 11 publications

(16 citation statements)

References 9 publications

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“…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.…”

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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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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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“…Thus, the percentage of patients with invasive meningococcal infection in which N. meningitidis can be isolated by standard micro- biological techniques has decreased. The use of LA for CSF allows the etiologic diagnosis especially in cases pre-treated with antibiotics (16). CSF direct examination and culture are positive in 80-90% of untreated cases of meningococcal infection, significantly reduced rate in case of prior antibiotic administration.…”

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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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“…Nevertheless, the reduction of secondary cases has almost no impact in the incidence of the disease in the community, as it accounts only 1-3% of all reported cases (Barroso et al 1998). The changing epidemiology of meningococcal disease is a fact observed naturally or through the implementation of vaccination (Barroso et al 1998, Carrol et al 2000, Harrison 2006). Vaccination is the most effective measure to control the disease caused by Neisseria meningitidis, a human pathogen spread through direct contact with respiratory secretions from the asymptomatic nasopharyngeal carriers (Barroso et al 1998, Harrison 2006.…”

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“…The case fatality rate of meningococcal disease is thought to be reduced by earlier treatment with parenteral antibiotics (Cartwright & Kroll 1997). Preadmission parenteral antibiotic is currently recommended and less lumbar punctures are done in patients with suspected meningococcal disease at presentation (Carrol et al 2000). Neither early antibiotic administration nor a delayed lumbar puncture hinders microbiological diagnosis when nucleic acid amplification assay is used (Cartwright & Kroll 1997, Carrol et al 2000, Ragunathan et al 2000, Clarke & Edwards 2003.…”

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confidence: 99%

“…Preadmission parenteral antibiotic is currently recommended and less lumbar punctures are done in patients with suspected meningococcal disease at presentation (Carrol et al 2000). Neither early antibiotic administration nor a delayed lumbar puncture hinders microbiological diagnosis when nucleic acid amplification assay is used (Cartwright & Kroll 1997, Carrol et al 2000, Ragunathan et al 2000, Clarke & Edwards 2003. We conducted an assessment of a two-step polymerase chain reaction (PCR) assay to detect N. meningitidis DNA in CSF samples from positive cases (culture or antigen detection or direct smear) followed by genogrouping, as an adjunct for field-based surveillance of meningococcal disease.…”

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Assessment of a two-step nucleic acid amplification assay for detection of Neisseria meningitidis followed by capsular genogrouping

Rebelo¹,

Boente

Matos

et al. 2006

Mem. Inst. Oswaldo Cruz

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Increasing microbiological confirmation and changing epidemiology of meningococcal disease on Merseyside, England

Abstract: Culture detection of meningococci from children with MCD has reduced, as less lumbar punctures are done. However, improved diagnosis by PCR and AD has increased microbiological confirmation overall. Serogroup C disease and the median age of cases continue to rise.

Cited by 11 publications

References 9 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

Assessment of a two-step nucleic acid amplification assay for detection of Neisseria meningitidis followed by capsular genogrouping

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