1
|
Detection of Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae in Culture Negative Cerebrospinal Fluid Samples from Meningitis Patients Using a Multiplex Polymerase Chain Reaction in Nepal. Infect Dis Rep 2021; 13:173-180. [PMID: 33804301 PMCID: PMC7930938 DOI: 10.3390/idr13010019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/02/2021] [Accepted: 02/07/2021] [Indexed: 11/17/2022] Open
Abstract
The rapid identification of bacteria causing meningitis is crucial as delays in the treatment increase mortality rate. Though considered as the gold standard for the laboratory diagnosis of bacterial meningitis, culture might give false negative results in a case of patients under antibiotics prior to lumbar puncture. This study aimed to detect Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae by a multiplex polymerase chain reaction (PCR) in culture-negative cerebrospinal fluid samples collected from clinically suspected meningitis cases attending different hospitals in Kathmandu, Nepal from January 2017 to December 2019. S. pneumoniae, N. meningitidis and H. influenzae were detected in 8.59% (33/384) of the specimens by PCR and 7.55% (29/384) of the specimens by culture. Correlation between culture and PCR of the same sample was good (Spearman's rho correlation coefficient = 0.932). However, the difference in positivity between culture and PCR was statistically not significant (p value > 0.05). In four specimens, culture could not detect any of the targeted bacteria whereas PCR could detect presence of H. influenzae. PCR increases the diagnostic yield for bacterial meningitis. PCR may be considered as an adjunctive test for establishing the cause of infection in culture negative clinically suspected meningitis cases.
Collapse
|
2
|
Mina Y, Schechner V, Savion M, Yahav D, Bilavsky E, Sorek N, Ben-Zvi H, Adler A. Clinical benefits of FilmArray meningitis-encephalitis PCR assay in partially-treated bacterial meningitis in Israel. BMC Infect Dis 2019; 19:713. [PMID: 31409318 PMCID: PMC6693273 DOI: 10.1186/s12879-019-4348-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/31/2019] [Indexed: 12/23/2022] Open
Abstract
Background Management of partially-treated, community-acquired bacterial meningitis (PCBM) is commonly compromised by lack of microbiological diagnosis. We aimed to analyze the impact of FilmArray Meningitis-Encephalitis (FA-ME) PCR on the management of PCBM. Methods Comparison of treatment variables of PCBM cases between two periods, before (6.5 years, control group) and after (2 years, study group) the application of FA-ME PCR assay. Results The total duration of antimicrobial treatment in the study group (n = 8) was significantly shorter than the control group (n = 23) (9.5 ± 3.7 days vs. 15.2 ± 5 days, p = 0.007). The percentage of narrow-spectrum regimens was significantly higher in the study group (78 ± 11% vs. 40 ± 9%, p = 0.03). There was a significant difference in implementation of antimicrobial chemoprophylaxis for close contacts (4/8 (50%) vs. 1/23 (4%), p = 0.01). Conclusions The use of FA-ME PCR provides significant benefits in the management of PCBM by shortening duration of antibiotic treatment, increasing the use of narrow-spectrum regimens, and allowing proper administration of antimicrobial chemoprophylaxis. Trial registration The study was approved and retrospectively registered by the Tel-Aviv Sourasky Medical Center (0378–17-TLV, 10/17/2017) and Rabin Medical Center (0270–18-RMC, 11/11/2018) Ethics committees and conforms to recognized standards.
Collapse
Affiliation(s)
- Yair Mina
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. .,Neurological Institute, Tel-Aviv Sourasky Medical Center, 6th Weizman street, Tel-Aviv, Israel.
| | - Vered Schechner
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Division of Epidemiology and Preventive Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Michal Savion
- Tel-Aviv District, Israel Ministry of Health, Tel-Aviv, Israel
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Efraim Bilavsky
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Pediatrics C, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Nadav Sorek
- Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Haim Ben-Zvi
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Amos Adler
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| |
Collapse
|
3
|
Abstract
Introduction of conjugate vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis has led to a substantial reduction in cases of acute bacterial meningitis in countries with high routine childhood immunization coverage. The majority of children hospitalized with meningitis in high-income countries have viral or aseptic meningitis and do not require antibiotic treatment. Cerebrospinal fluid analysis is irreplaceable in appropriately diagnosing and treating bacterial meningitis and avoiding unnecessary antibiotics and prolonged hospitalizations in children with viral meningitis. New diagnostic tests have improved detection of bacterial and viral pathogens in cerebrospinal fluid, underscoring the importance of promptly performing lumbar puncture when meningitis is suspected. This article provides an overview of acute bacterial and viral meningitis in children, focusing on the changing epidemiology, the advantages and limitations of conventional and newer diagnostic methods, and considerations for clinical practice.
Collapse
|
4
|
Ramasamy R, Willis L, Kadambari S, Kelly DF, Heath PT, Nadel S, Pollard AJ, Sadarangani M. Management of suspected paediatric meningitis: a multicentre prospective cohort study. Arch Dis Child 2018; 103:1114-1118. [PMID: 29436406 DOI: 10.1136/archdischild-2017-313913] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 01/12/2018] [Accepted: 01/20/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To quantify delays during management of children with suspected meningitis. DESIGN Multicentre prospective cohort study. SETTING Three UK tertiary paediatric centres; June 2011-June 2012 PATIENTS: 388 children aged <16 years hospitalised with suspected meningitis or undergoing lumbar puncture (LP) during sepsis evaluation. MAIN OUTCOME MEASURES Time of prehospital and in-hospital assessments, LP, antibiotic treatment and discharge; types of prehospital medical assessment and microbiological results. Data collected from hospital records and parental interview. RESULTS 220/388 (57%) children were seen by a medical professional prehospitalisation (143 by a general practitioner). Median times from initial hospital assessment to LP and antibiotic administration were 4.8 hours and 3.1 hours, respectively; 62% of children had their LP after antibiotic treatment. Median time to LP was shorter for children aged <3 months (3.0 hours) than those aged 3-23 months (6.2 hours, P<0.001) or age ≥2 years (20.3 hours, P<0.001). In meningitis of unknown cause, cerebrospinal fluid (CSF) PCR was performed for meningococcus in 7%, pneumococcus in 10% and enterovirus in 76%. When no pathogen was identified, hospital stay was longer if LP was performed after antibiotics (median 12.5 days vs 5.0 days, P=0.037). CONCLUSIONS Most children had LP after antibiotics were administered, reducing yield from CSF culture, and PCRs were underused despite national recommendations. These deficiencies reduce the ability to exclude bacterial meningitis, increasing unnecessary hospital stay and antibiotic treatment.
Collapse
Affiliation(s)
- Roshan Ramasamy
- Department of Emergency Medicine, Northwick Park Hospital, London, UK
| | - Louise Willis
- Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Seilesh Kadambari
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Dominic F Kelly
- Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Simon Nadel
- Department of Paediatrics, St Mary's Hospital, London, UK
| | - Andrew J Pollard
- Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
5
|
Use of a Molecular Panel To Aid in Diagnosis of Culture-Negative Meningitis. J Clin Microbiol 2016; 54:3069-3070. [PMID: 27682130 DOI: 10.1128/jcm.01957-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
|
6
|
Identification of Common Bacterial Pathogens Causing Meningitis in Culture-Negative Cerebrospinal Fluid Samples Using Real-Time Polymerase Chain Reaction. Int J Microbiol 2016; 2016:4197187. [PMID: 27563310 PMCID: PMC4983665 DOI: 10.1155/2016/4197187] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/18/2016] [Accepted: 07/04/2016] [Indexed: 12/04/2022] Open
Abstract
Background. Meningitis is a serious communicable disease with high morbidity and mortality rates. It is an endemic disease in Egypt caused mainly by Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. In some settings, bacterial meningitis is documented depending mainly on positive cerebrospinal fluid (CSF) culture results or CSF positive latex agglutination test, missing the important role of prior antimicrobial intake which can yield negative culture and latex agglutination test results. This study aimed to utilize molecular technology in order to diagnose bacterial meningitis in culture-negative CSF samples. Materials and Methods. Forty culture-negative CSF samples from suspected cases of bacterial meningitis were examined by real-time polymerase chain reaction (real-time PCR) for the presence of lytA, bexA, and ctrA genes specific for Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, respectively. Results. Positive real-time PCR results for Streptococcus pneumoniae were detected in 36 (90%) of culture-negative CSF samples while no positive results for Haemophilus influenzae or Neisseria meningitidis were detected. Four (10%) samples were negative by real-time PCR for all tested organisms. Conclusion. The use of molecular techniques as real-time PCR can provide a valuable addition to the proportion of diagnosed cases of bacterial meningitis especially in settings with high rates of culture-negative results.
Collapse
|
7
|
Comparison of PCR-based methods for the simultaneous detection of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae in clinical samples. Braz J Infect Dis 2016; 20:335-41. [PMID: 27256956 PMCID: PMC9427638 DOI: 10.1016/j.bjid.2016.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 04/12/2016] [Accepted: 04/14/2016] [Indexed: 11/21/2022] Open
Abstract
Background Several in-house PCR-based assays have been described for the detection of bacterial meningitis caused by Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae from clinical samples. PCR-based methods targeting different bacterial genes are frequently used by different laboratories worldwide, but no standard method has ever been established. The aim of our study was to compare different in-house and a commercial PCR-based tests for the detection of bacterial pathogens causing meningitis and invasive disease in humans. Methods A total of 110 isolates and 134 clinical samples (99 cerebrospinal fluid and 35 blood samples) collected from suspected cases of invasive disease were analyzed. Specific sets of primers frequently used for PCR-diagnosis of the three pathogens were used and compared with the results achieved using the multiplex approach described here. Several different gene targets were used for each microorganism, namely ctrA, crgA and nspA for N. meningitidis, ply for S. pneumoniae, P6 and bexA for H. influenzae. Results All used methods were fast, specific and sensitive, while some of the targets used for the in-house PCR assay detected lower concentrations of genomic DNA than the commercial method. An additional PCR reaction is described for the differentiation of capsulated and non-capsulated H. influenzae strains, the while commercial method only detects capsulated strains. Conclusions The in-house PCR methods here compared showed to be rapid, sensitive, highly specific, and cheaper than commercial methods. The in-house PCR methods could be easily adopted by public laboratories of developing countries for diagnostic purposes. The best results were achieved using primers targeting the genes nspA, ply, and P6 which were able to detect the lowest DNA concentrations for each specific target.
Collapse
|
8
|
Ramautar AE, Halse TA, Arakaki L, Antwi M, Del Rosso P, Dorsinville M, Nazarian E, Steiner-Sichel L, Lee L, Dickinson M, Wroblewski D, Dumas N, Musser K, Isaac B, Rakeman J, Weiss D. Direct molecular testing to assess the incidence of meningococcal and other bacterial causes of meningitis among persons reported with unspecified bacterial meningitis. Diagn Microbiol Infect Dis 2015; 83:305-11. [DOI: 10.1016/j.diagmicrobio.2015.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/05/2015] [Accepted: 06/10/2015] [Indexed: 11/29/2022]
|
9
|
Sáfadi MAP, de los Monteros LEE, López EL, Sàez-Llorens X, Lemos AP, Moreno-Espinosa S, Ayala SG, Torres JP, de Moraes JC, Vázquez JA. The current situation of meningococcal disease in Latin America and recommendations for a new case definition from the Global Meningococcal Initiative. Expert Rev Vaccines 2013; 12:903-15. [PMID: 23909747 DOI: 10.1586/14760584.2013.814879] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The Global Meningococcal Initiative (GMI) is an international group of scientists and clinicians with expertise in meningococcal disease (MD). It promotes MD prevention through education and research. Given geographic differences in disease epidemiology, prevention strategies (e.g., vaccination) should be country-specific to ensure local needs are met. However, regional policies/recommendations and standardized disease diagnostic criteria should be implemented to improve surveillance and control strategies, and allow for more robust data comparisons. Consequently, the GMI convened a meeting with Latin American representatives to discuss the burden of MD and vaccination practices/policies, and consider if the global GMI recommendations could be tailored. The group determined that as robust, uniform epidemiologic data are required to make informed health-policy decisions, it would be useful to first summarize the regional situation herein (including disease surveillance, case definitions, epidemiology, vaccination and outbreak control strategies) and then determine a consensus-based meningococcal case definition for use throughout the region.
Collapse
Affiliation(s)
- Marco Aurélio P Sáfadi
- FCM da Santa Casa de São Paulo, Alameda dos Indigenas, 228, ZIP 04059 060, São Paulo, Brazil.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
A multi-target real-time PCR assay for rapid identification of meningitis-associated microorganisms. Mol Biotechnol 2013; 53:74-9. [PMID: 22450734 DOI: 10.1007/s12033-012-9534-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A central nervous system (CNS) infection, such as meningitis, is a serious and life-threatening condition. Bacterial meningitis can be severe and may result in brain damage, disability or even death. Rapid diagnosis of CNS infections and identification of the pathogenic microorganisms are needed to improve the patient outcome. Bacterial culture of a patient's cerebrospinal fluid (CSF) is currently considered the "gold standard" for diagnosing bacterial meningitis. From the CSF cultures researchers can assess the in vitro susceptibility of the causative microorganism to determine the best antibiotic treatment. However, many of the culture assays, such as microscopy and the latex agglutination test are not sensitive. To enhance pathogen detection in CSF samples we developed a multi-target real-time PCR assay that can rapidly identify six different microorganisms: Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Streptococcus agalactiae, Listeria monocytogenes and Cryptococcus neoformans. In this study we applied this PCR analysis to 296 CSF samples from patients who were suspected of having meningitis. Of the 296 samples that were examined, 59 samples were positive according to the CSF culture and/or molecular assays. Forty-six CSF samples were positive for both the CSF culture and our real-time PCR assay, while 13 samples were positive for the real-time PCR but negative for the traditional assays. This discrepancy may have been caused by the fact that these samples were collected from 23 patients who were treated with antimicrobials before CSF sampling.
Collapse
|
11
|
Clinical presentation of invasive pneumococcal disease in Spain in the era of heptavalent conjugate vaccine. Pediatr Infect Dis J 2012; 31:124-8. [PMID: 22173137 DOI: 10.1097/inf.0b013e318241d09e] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to analyze the rate of incidence, clinical presentation, serotype, and clonal distribution of invasive pneumococcal disease (IPD) in the era of heptavalent pneumococcal conjugate vaccine (PCV7) in Barcelona, Spain. METHODS This was a prospective study comprising all children <5 years with IPD who were managed in 2 tertiary-care, pediatric hospitals between January 2007 and December 2009. IPD was defined as the presence of clinical findings of infection together with isolation or detection of DNA of Streptococcus pneumoniae in a sterile fluid sample. RESULTS In this study, 319 patients (53.3% male), mean age 29.6 months, were included. Comparing rates in 2007 and 2009 (76.2 and 109.9 episodes/100,000 population, respectively), an increase of 44% (95% confidence interval, 10%-89%) was observed. The main clinical presentation was pneumonia (254 episodes, 79.6%), followed by meningitis (29, 9.1%), and bacteremia (25, 7.8%).The diagnosis was made by positive culture in 123 (38.6%) patients and in 196 (61.4%) by real-time polymerase chain reaction. Serotype study was performed in 300 episodes, and 273 (91%) were non-PCV7 serotypes. The most frequent serotypes were 1 (20.7%), 19A (15.7%), and 3 (12.3%). A minimal inhibitory concentration ≥0.12 μg/mL to penicillin was detected in 34.4% of isolates. Sequence type 306 expressing serotype 1 was the most frequent clonal type detected (20.3% of studied strains). CONCLUSIONS IPD continues to increase in Barcelona, and the rate is higher than previously reported as a result of low sensitivity of bacterial culture. Non-PCV7 serotypes were responsible for 91% of episodes and pneumonia was the main clinical presentation.
Collapse
|
12
|
Serotype 3 is a common serotype causing invasive pneumococcal disease in children less than 5 years old, as identified by real-time PCR. Eur J Clin Microbiol Infect Dis 2011; 31:1487-95. [DOI: 10.1007/s10096-011-1468-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 10/17/2011] [Indexed: 10/15/2022]
|
13
|
Abstract
Nearly 70 years after the discovery of penicillin, neurologic infectious diseases (NIDs) remain an important worldwide source of morbidity and mortality. The clinician faced with a potential NID must urgently consider patient demographics, pace of illness and clinical syndrome, and laboratory data. In keeping with the topics of this issue, initial emergency diagnosis and management are emphasized, with appropriate references to relevant literature for subsequent longer-term interventions.
Collapse
Affiliation(s)
- Amy A Pruitt
- Department of Neurology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| |
Collapse
|
14
|
Update on the Detection and Characterization of Bacterial Pathogens by Nucleic Acid Amplification. Mol Microbiol 2011. [DOI: 10.1128/9781555816834.ch23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
15
|
Dolan Thomas J, Hatcher CP, Satterfield DA, Theodore MJ, Bach MC, Linscott KB, Zhao X, Wang X, Mair R, Schmink S, Arnold KE, Stephens DS, Harrison LH, Hollick RA, Andrade AL, Lamaro-Cardoso J, de Lemos APS, Gritzfeld J, Gordon S, Soysal A, Bakir M, Sharma D, Jain S, Satola SW, Messonnier NE, Mayer LW. sodC-based real-time PCR for detection of Neisseria meningitidis. PLoS One 2011; 6:e19361. [PMID: 21573213 PMCID: PMC3088665 DOI: 10.1371/journal.pone.0019361] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 04/04/2011] [Indexed: 11/18/2022] Open
Abstract
Real-time PCR (rt-PCR) is a widely used molecular method for detection of Neisseria meningitidis (Nm). Several rt-PCR assays for Nm target the capsule transport gene, ctrA. However, over 16% of meningococcal carriage isolates lack ctrA, rendering this target gene ineffective at identification of this sub-population of meningococcal isolates. The Cu-Zn superoxide dismutase gene, sodC, is found in Nm but not in other Neisseria species. To better identify Nm, regardless of capsule genotype or expression status, a sodC-based TaqMan rt-PCR assay was developed and validated. Standard curves revealed an average lower limit of detection of 73 genomes per reaction at cycle threshold (C(t)) value of 35, with 100% average reaction efficiency and an average R(2) of 0.9925. 99.7% (624/626) of Nm isolates tested were sodC-positive, with a range of average C(t) values from 13.0 to 29.5. The mean sodC C(t) value of these Nm isolates was 17.6±2.2 (±SD). Of the 626 Nm tested, 178 were nongroupable (NG) ctrA-negative Nm isolates, and 98.9% (176/178) of these were detected by sodC rt-PCR. The assay was 100% specific, with all 244 non-Nm isolates testing negative. Of 157 clinical specimens tested, sodC detected 25/157 Nm or 4 additional specimens compared to ctrA and 24 more than culture. Among 582 carriage specimens, sodC detected Nm in 1 more than ctrA and in 4 more than culture. This sodC rt-PCR assay is a highly sensitive and specific method for detection of Nm, especially in carriage studies where many meningococcal isolates lack capsule genes.
Collapse
Affiliation(s)
- Jennifer Dolan Thomas
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial
Diseases, National Center for Immunization and Respiratory Diseases, Centers for
Disease Control and Prevention, Atlanta, Georgia, United States of
America
- * E-mail:
| | - Cynthia P. Hatcher
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial
Diseases, National Center for Immunization and Respiratory Diseases, Centers for
Disease Control and Prevention, Atlanta, Georgia, United States of
America
| | - Dara A. Satterfield
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial
Diseases, National Center for Immunization and Respiratory Diseases, Centers for
Disease Control and Prevention, Atlanta, Georgia, United States of
America
- Biology Department, Agnes Scott College, Decatur, Georgia, United States
of America
| | - M. Jordan Theodore
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial
Diseases, National Center for Immunization and Respiratory Diseases, Centers for
Disease Control and Prevention, Atlanta, Georgia, United States of
America
| | - Michelle C. Bach
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial
Diseases, National Center for Immunization and Respiratory Diseases, Centers for
Disease Control and Prevention, Atlanta, Georgia, United States of
America
- Biology Department, Agnes Scott College, Decatur, Georgia, United States
of America
| | - Kristin B. Linscott
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial
Diseases, National Center for Immunization and Respiratory Diseases, Centers for
Disease Control and Prevention, Atlanta, Georgia, United States of
America
- Biology Department, Agnes Scott College, Decatur, Georgia, United States
of America
| | - Xin Zhao
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial
Diseases, National Center for Immunization and Respiratory Diseases, Centers for
Disease Control and Prevention, Atlanta, Georgia, United States of
America
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial
Diseases, National Center for Immunization and Respiratory Diseases, Centers for
Disease Control and Prevention, Atlanta, Georgia, United States of
America
| | - Raydel Mair
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial
Diseases, National Center for Immunization and Respiratory Diseases, Centers for
Disease Control and Prevention, Atlanta, Georgia, United States of
America
| | - Susanna Schmink
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial
Diseases, National Center for Immunization and Respiratory Diseases, Centers for
Disease Control and Prevention, Atlanta, Georgia, United States of
America
| | - Kathryn E. Arnold
- Division of Public Health, Georgia Department of Community Health,
Atlanta, Georgia, United States of America
- Georgia Emerging Infections Program, Atlanta, Georgia, United States of
America
| | - David S. Stephens
- Emory University School of Medicine, Atlanta, Georgia, United States of
America
- Georgia Emerging Infections Program, Atlanta, Georgia, United States of
America
- Veterans Affairs Medical Center, Atlanta, Georgia, United States of
America
| | - Lee H. Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,
United States of America
| | - Rosemary A. Hollick
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,
United States of America
| | - Ana Lucia Andrade
- Instituto de Patologia Tropical e Saúde Pública,
Universidade Federal de Goiás, Goiânia, Goiás,
Brazil
| | - Juliana Lamaro-Cardoso
- Instituto de Patologia Tropical e Saúde Pública,
Universidade Federal de Goiás, Goiânia, Goiás,
Brazil
| | | | - Jenna Gritzfeld
- Respiratory Infection, Clinical Group, Liverpool School of Tropical
Medicine, Liverpool, United Kingdom
| | - Stephen Gordon
- Respiratory Infection, Clinical Group, Liverpool School of Tropical
Medicine, Liverpool, United Kingdom
| | - Ahmet Soysal
- Division of Pediatric Infectious Diseases, Marmara University School of
Medicine, Istanbul, Turkey
| | - Mustafa Bakir
- Division of Pediatric Infectious Diseases, Marmara University School of
Medicine, Istanbul, Turkey
| | - Dolly Sharma
- Emory University School of Medicine, Atlanta, Georgia, United States of
America
- Children's Healthcare of Atlanta, Atlanta, Georgia, United States of
America
| | - Shabnam Jain
- Emory University School of Medicine, Atlanta, Georgia, United States of
America
- Children's Healthcare of Atlanta, Atlanta, Georgia, United States of
America
| | - Sarah W. Satola
- Emory University School of Medicine, Atlanta, Georgia, United States of
America
- Georgia Emerging Infections Program, Atlanta, Georgia, United States of
America
- Veterans Affairs Medical Center, Atlanta, Georgia, United States of
America
| | - Nancy E. Messonnier
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial
Diseases, National Center for Immunization and Respiratory Diseases, Centers for
Disease Control and Prevention, Atlanta, Georgia, United States of
America
| | - Leonard W. Mayer
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial
Diseases, National Center for Immunization and Respiratory Diseases, Centers for
Disease Control and Prevention, Atlanta, Georgia, United States of
America
| |
Collapse
|
16
|
Azzari C, Cortimiglia M, Moriondo M, Canessa C, Lippi F, Ghiori F, Becciolini L, de Martino M, Resti M. Pneumococcal DNA is not detectable in the blood of healthy carrier children by real-time PCR targeting the lytA gene. J Med Microbiol 2011; 60:710-714. [PMID: 21349984 PMCID: PMC3167920 DOI: 10.1099/jmm.0.028357-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The diagnosis of invasive pneumococcal disease (IPD) is currently based on culture methods, which lack sensitivity, especially after antibiotic therapy. Molecular methods have improved sensitivity and do not require viable bacteria; however, their use is complicated by reports of low specificity with some assays. The present study investigated the specificity of a real-time PCR targeting lytA for the detection of IPD. A group of 147 healthy children, aged 6 months to 16 years (mean 6.4 years, median 4.9 years, interquartile range 6.4 years), who were in hospital for routine examinations, were tested for pneumococcal carrier status and for the presence of detectable pneumococcal DNA in their blood by real-time PCR targeting the pneumococcal lytA gene. In addition, 35 culture-positive biological samples were analysed. Urine was examined for the presence of pneumococcal DNA and C-polysaccharide antigen. Carriage was detected in 77 of the 147 subjects (52.4 %); however, regardless of carrier status, none of the subjects had a positive result from blood. Analysis of the culture-positive biological samples yielded positive results in 100 % (15/15) of cerebrospinal fluid samples and 95 % (19/20) of blood samples. All urine samples from healthy carriers were negative for DNA, whilst antigenuria was detected in 44/77 carriers (57.1 %). In conclusion, real-time PCR is both sensitive and specific and can be a useful tool in the routine diagnosis of IPD. Its sensitivity, which surpasses that of other methods for this purpose, does not come at the cost of reduced specificity.
Collapse
Affiliation(s)
- Chiara Azzari
- Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Martina Cortimiglia
- Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Maria Moriondo
- Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Clementina Canessa
- Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Francesca Lippi
- Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Federica Ghiori
- Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Laura Becciolini
- Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Maurizio de Martino
- Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Massimo Resti
- Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| |
Collapse
|
17
|
Rothman R, Ramachandran P, Yang S, Hardick A, Won H, Kecojevic A, Quianzon C, Hsieh YH, Gaydos C. Use of quantitative broad-based polymerase chain reaction for detection and identification of common bacterial pathogens in cerebrospinal fluid. Acad Emerg Med 2010; 17:741-7. [PMID: 20653589 DOI: 10.1111/j.1553-2712.2010.00790.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Conventional laboratory diagnosis of bacterial meningitis based on microscopy followed by culture is time-consuming and has only moderate sensitivity. OBJECTIVES The objective was to define the limit of detection (LOD), analytic specificity, and performance characteristics of a broad-based quantitative multiprobe polymerase chain reaction (PCR) assay for rapid bacterial detection and simultaneous pathogen-specific identification in patients with suspected meningitis. METHODS A PCR algorithm consisting of initial broad-based detection of Eubacteriales by a universal probe, followed by pathogen identification using either pathogen-specific probes or Gram-typing probes, was employed to detect pathogens. The 16S rRNA gene, which contains both conserved and variable regions, was chosen as the target. Pathogen-specific probes were designed for Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Staphylococcus epidermidis, Staphylococcus aureus, Escherichia coli, and Listeria monocytogenes. Gram-positive and -negative typing probes were designed based on conserved regions across all eubacteria. The LOD and time to detection were assessed by dilutional mocked-up samples. A total of 108 convenience cerebrospinal fluid (CSF) clinical samples obtained from the Johns Hopkins Hospital (JHH) microbiology laboratory were tested, and results were compared with hospital microbiologic culture reports. RESULTS The LOD of the assay ranged from 10(1) to 10(2) colony-forming units (CFU)/mL. Pathogen-specific probes showed no cross-reactivity with other organisms. Time to detection was 3 hours. In clinical specimens, the universal probe correctly detected 16 of 22 culture-positive clinical specimens (sensitivity = 72.7%; 95% confidence interval [CI] = 49.8% to 89.3%), which were all correctly characterized by either pathogen-specific or Gram-typing probes. Adjusted sensitivity after removing probable microbiologic laboratory contaminants was 88.9% (95% CI = 65.3% to 98.6%). The universal probe was negative for 86 of 86 culture-negative specimens. CONCLUSIONS A broad-based multiprobe PCR assay demonstrated strong analytic performance characteristics. Findings from a pilot clinical study showed promise in translation to human subjects, supporting potential utility of the assay as an adjunct to traditional diagnostics for early identification of bacterial meningitis.
Collapse
Affiliation(s)
- Richard Rothman
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
PCR using blood for diagnosis of invasive pneumococcal disease: systematic review and meta-analysis. J Clin Microbiol 2009; 48:489-96. [PMID: 20007385 DOI: 10.1128/jcm.01636-09] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The use of molecular-based methods for the diagnosis of bacterial infections in blood is appealing, but they have not yet passed the threshold for clinical practice. A systematic review of prospective and case-control studies assessing the diagnostic utility of PCR directly with blood samples for the diagnosis of invasive pneumococcal disease (IPD) was performed. A broad search was conducted to identify published and unpublished studies. Two reviewers independently extracted the data. Summary estimates for sensitivity and specificity with 95% confidence intervals (CIs) were calculated by using the hierarchical summary receiver operating characteristic method. The effects of sample processing, PCR type, the gene-specific primer, study design, the participants' age, and the source of infection on the diagnostic odds ratios were assessed through meta-regression. Twenty-nine studies published between 1993 and 2009 were included. By using pneumococcal bacteremia for case definition and healthy people or patients with bacteremia caused by other bacteria as controls (22 studies), the summary estimates for sensitivity and specificity were 57.1% (95% CI, 45.7 to 67.8%) and 98.6% (95% CI, 96.4 to 99.5%), respectively. When the controls were patients suspected of having IPD without pneumococcal bacteremia (26 studies), the respective values were 66.4% (95% CI, 55.9 to 75.6%) and 87.8% (95% CI, 79.5 to 93.1%). With lower degrees of proof for IPD (any culture or serology result and the clinical impression), the sensitivity of PCR decreased and the specificity increased. All analyses were highly heterogeneous. The use of nested PCR and being a child were associated with low specificity, while the use of a cohort study design was associated with a low sensitivity. The lack of an appropriate reference standard might have caused underestimation of the performance of the PCR. Currently available methods for PCR with blood samples for the diagnosis of IPD lack the sensitivity and specificity necessary for clinical practice.
Collapse
|
19
|
Carbonnelle E. Apport des examens biologiques dans le diagnostic positif, la détermination de l’étiologie et le suivi d’une méningite suspectée bactérienne. Med Mal Infect 2009; 39:581-605. [DOI: 10.1016/j.medmal.2009.02.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 02/20/2009] [Indexed: 01/03/2023]
|
20
|
|
21
|
Vu Thien H. [Contribution of microbiological methods to the diagnosis of acute bacterial meningitis]. Med Mal Infect 2009; 39:462-7. [PMID: 19394176 DOI: 10.1016/j.medmal.2009.02.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 02/20/2009] [Indexed: 11/27/2022]
Abstract
The most frequent bacteria responsible for acute bacterial meningitis, after the neonatal period, are meningoccoci and pneumococci, very rarely Haemophilus influenzae and Listeria monocytogenes. The microbiological diagnosis is based on cell count, Gram stain, and culture of cerebrospinal fluid. Antigen detection and DNA detection are useful to identify the bacteria in cases of negative cultures, because of the fragility of some bacterial species (meningococci), or a prior antibiotic administration, before a lumbar puncture. Some tests for screening antimicrobial resistances are needed, such as those for detection of resistance to betalactam agents in pneumococcal isolates. Blood cultures, serum samples, skin rash biopsies also contribute to the diagnosis.
Collapse
Affiliation(s)
- H Vu Thien
- Service de microbiologie, hôpital Armand-Trousseau, Assistance publique-Hôpitaux de Paris, 26, avenue du Dr-Netter, 75571 Paris cedex 12, France.
| |
Collapse
|
22
|
Azzari C, Moriondo M, Indolfi G, Massai C, Becciolini L, de Martino M, Resti M. Molecular detection methods and serotyping performed directly on clinical samples improve diagnostic sensitivity and reveal increased incidence of invasive disease by Streptococcus pneumoniae in Italian children. J Med Microbiol 2008; 57:1205-1212. [PMID: 18809546 PMCID: PMC2884936 DOI: 10.1099/jmm.0.2008/000935-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2008] [Accepted: 04/22/2008] [Indexed: 11/18/2022] Open
Abstract
The aims of this study were to evaluate the incidence of invasive pneumococcal disease (IPD) in Italian children and perform serotyping by PCR-based assays directly on clinical samples. A 1-year paediatric (0-14 years) population-based surveillance study was designed to evaluate the incidence of IPD in the province of Florence, Italy, by cultural and molecular methods. Among 92 children (80 with pneumonia, 8 with meningitis/sepsis, 4 with arthritis), 4 cases of IPD were diagnosed both by culture and real-time PCR and 18 cases exclusively by molecular methods. The sensitivity of molecular methods was significantly higher than that of cultural methods (Cohen's kappa 0.41; McNemar P=0.000008). The incidence of IPD in children below 2 years of age was 11.5/100,000 and 51.8/100,000 by cultural and molecular methods, respectively. Pneumococcal serotyping by multiplex sequential PCR was obtained in 19/22 samples. Real-time PCR and multiplex sequential PCR can be used directly on biological samples, improving the ability to diagnose IPD. The incidence of IPD appears 5-10 times higher by PCR than by cultural methods.
Collapse
Affiliation(s)
- Chiara Azzari
- Department of Paediatrics, University of Florence and Anna Meyer Children's Hospital, Viale Pieraccini 24, Florence I-50139, Italy
| | - Maria Moriondo
- Department of Paediatrics, University of Florence and Anna Meyer Children's Hospital, Viale Pieraccini 24, Florence I-50139, Italy
| | - Giuseppe Indolfi
- Department of Paediatrics, University of Florence and Anna Meyer Children's Hospital, Viale Pieraccini 24, Florence I-50139, Italy
| | - Cristina Massai
- Department of Paediatrics, University of Florence and Anna Meyer Children's Hospital, Viale Pieraccini 24, Florence I-50139, Italy
| | - Laura Becciolini
- Department of Paediatrics, University of Florence and Anna Meyer Children's Hospital, Viale Pieraccini 24, Florence I-50139, Italy
| | - Maurizio de Martino
- Department of Paediatrics, University of Florence and Anna Meyer Children's Hospital, Viale Pieraccini 24, Florence I-50139, Italy
| | - Massimo Resti
- Department of Paediatrics, University of Florence and Anna Meyer Children's Hospital, Viale Pieraccini 24, Florence I-50139, Italy
| |
Collapse
|
23
|
|
24
|
|