Modification of Laboratory Results by Partial Treatment of Bacterial Meningitis

Dalton, Harry P.; Allison, Marvin J.

doi:10.1093/ajcp/49.3.410

Cited by 54 publications

(30 citation statements)

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“…The CSF Gram staining procedure is expected to reveal the presence of organisms in no more than 60 to 90% of cases (5,6). The sensitivity of Gram stain examination is even lower in patients who have received antimicrobial therapy prior to lumbar puncture (4,6,9). Prior antimicrobial therapy may also result in negative CSF and blood cultures.…”

mentioning

confidence: 99%

Evaluation of a Rapid PCR Assay for Diagnosis of Meningococcal Meningitis

Richardson

Louie

et al. 2003

J Clin Microbiol

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confidence: 99%

Evaluation of a Rapid PCR Assay for Diagnosis of Meningococcal Meningitis

Richardson

Louie

et al. 2003

J Clin Microbiol

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“…The identification of the specific bacteria and determination of antibiotic susceptibility requires bacterial culture. Initiation of antibiotic therapy prior to sample collection and analysis can reduce the accuracy of both Gram stain and culture methods [9]. In this regard, PCR can be a useful adjunctive test, especially in patients who have already received antibiotics.…”

Section: Discussionmentioning

confidence: 99%

“…Gram stain examination of CSF permits a rapid, inexpensive, and accurate identification of the causative bacterium, but it is less sensitive than culture and our RT-PCR. In addition, the diagnosis of meningitis by Gram stain and culture of CSF may be 20% and 30% lower, respectively, in patients who have received prior antimicrobial therapy [9].…”

Section: Discussionmentioning

confidence: 99%

“…The etiological diagnosis of bacterial meningitis can be difficult to establish due to an increase in the practice of starting antimicrobial therapy prior to clinical sample collection. This practice has been reported to decrease the ability to culture and identify the pathogens causing bacterial meningitis and septicemia by approximately 30% [8][9].…”

Section: Introductionmentioning

confidence: 99%

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A duplex real-time PCR for the detection of Streptococcus pneumoniae and Neisseria meningitidis in cerebrospinal fluid

Diawara

Katfy

Zerouali

et al. 2016

J Infect Dev Ctries

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Introduction: Acute bacterial meningitis is one of the most severe infectious diseases. Rapid, accurate, and inexpensive diagnosis of bacterial meningitis is crucial for patient management. This study describes a duplex real-time (RT) PCR assay for detection of Neisseria meningitidis and Streptococcus pneumoniae in the cerebrospinal fluid (CSF) for meningitis diagnosis using SYBR Green-based RT-PCR method coupled with melting curve analysis. Methodology: We used SYBR Green-based RT-PCR method coupled with melting curve analysis to detect S. pneumoniae and N. meningitidis in CSF samples. The sensitivity, specificity, and limit of detection were determined. The gold standard for routine tests of CSF analysis is direct examination, culture, and/or latex agglutination. The assay was evaluated on 132 CSF samples to measure clinical sensitivity. Results: A duplex RT-PCR assay for N. meningitidis and S. pneumoniae detection in CSF was evaluated. Two peaks at different melting temperatures (87.5°C and 85.5°C) for N. meningitidis and S. pneumoniae, respectively, were obtained. The sensitivity of RT-PCR was 100% (95% confidence limits [CI] = 82.4-100) for N. meningitidis and 100% (95% CI = 85.1-100) for S. pneumoniae. Specificity was the same (100%) for the bacteria (95% CI = 88.6-100). The percentage of cases accurately diagnosed with meningitis caused by N. meningitidis and S. pneumoniae increased to 50.7% and 28.6%, respectively, when RT-PCR was added to the standard microbiologic methods. Conclusions: Duplex RT-PCR and melting curve analysis with SYBR Green is an inexpensive, sensitive, and specific method to rapidly diagnose bacterial meningitis. Accurate identification of the bacterial causative agents will improve patient management and epidemiological investigations.

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“…This might be expected taking into account the prevalence of meningococcal disease and the high susceptibility of the bacteria to antibiotic clearance in the vasculature and CSF (Stephens 2007). Partial antibiotic therapy has considerable effect on recovery of N. meningitidis, but not when meningitis is caused by H. influenzae (Dalton & Allison 1968) and, particularly, S. pneumoniae (Feldman 1978, Kanegaye et al 2001. Besides, the majority of notified cases of meningococcal disease (73%; 1,533/2,111) between 2001 and 2005, were based only on clinical observations (clinically diagnosed bacterial meningitis with a suggestive rash or purpura fulminans) accompanied by a high case-fatality rate (24%; 362/1,533); an indication of failure to diagnose the less severe cases, such as those without skin manifestation (WHO 1998).…”

Section: Discussionmentioning

confidence: 99%