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Obaro S, Hassan-Hanga F, Medugu N, Olaosebikan R, Olanipekun G, Jibir B, Gambo S, Ajose T, Duru C, Ebruke B, Davies HD. Comparison of bacterial culture with BioFire® FilmArray® multiplex PCR screening of archived cerebrospinal fluid specimens from children with suspected bacterial meningitis in Nigeria. BMC Infect Dis 2023; 23:641. [PMID: 37784010 PMCID: PMC10544496 DOI: 10.1186/s12879-023-08645-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Diagnosis of bacterial meningitis remains a challenge in most developing countries due to low yield from bacterial culture, widespread use of non-prescription antibiotics, and weak microbiology laboratories. The objective of this study was to compare the yield from standard bacterial culture with the multiplex nested PCR platform, the BioFire® FilmArray® Meningitis/Encephalitis Panel (BioFire ME Panel), for cases with suspected acute bacterial meningitis. METHODS Following Gram stain and bacterial culture on cerebrospinal fluid (CSF) collected from children aged less than 5 years with a clinical suspicion of acute bacterial meningitis (ABM) as defined by the WHO guidelines, residual CSF specimens were frozen and later tested by BioFire ME Panel. RESULTS A total of 400 samples were analyzed. Thirty-two [32/400 (8%)] of the specimens were culture positive, consisting of; three Salmonella spp. (2 Typhi and 1 non-typhi), three alpha hemolytic Streptococcus, one Staphylococcus aureus, six Neisseria meningitidis, seven Hemophilus influenzae, 11 Streptococcus pneumoniae and 368 were culture negative. Of the 368 culture-negative specimens, the BioFire ME Panel detected at least one bacterial pathogen in 90 (24.5%) samples, consisting of S. pneumoniae, N. meningitidis and H. influenzae, predominantly. All culture positive specimens for H. influenzae, N. meningitidis and S. pneumoniae also tested positive with the BioFire ME Panel. In addition, 12 specimens had mixed bacterial pathogens identified. For the first time in this setting, we have data on the viral agents associated with meningitis. Single viral agents were detected in 11 (2.8%) samples while co-detections with bacterial agents or other viruses occurred in 23 (5.8%) of the samples. CONCLUSIONS The BioFire® ME Panel was more sensitive and rapid than culture for detecting bacterial pathogens in CSF. The BioFire® ME Panel also provided for the first time, the diagnosis of viral etiologic agents that are associated with meningoencephalitis in this setting. Institution of PCR diagnostics is recommended as a routine test for suspected cases of ABM to enhance early diagnosis and optimal treatment.
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Affiliation(s)
- S Obaro
- Division of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, US
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - F Hassan-Hanga
- Department of Pediatrics, Aminu Kano Teaching Hospital, Bayero University/ Bayero University, Kano, Nigeria
| | - N Medugu
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria.
- Department of Medical Microbiology and Immunology, Nile University of Nigeria, Abuja, Nigeria.
| | - R Olaosebikan
- Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, US
| | - G Olanipekun
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - B Jibir
- Hasiya Bayero Pediatric Hospital, Kano, Nigeria
| | - S Gambo
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Theresa Ajose
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - Carissa Duru
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - B Ebruke
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - H D Davies
- Division of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, US
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Tsai WC, Chen SF, Chang WN, Lu CH, Chuang YC, Tsai NW, Chang CC, Chien CC, Huang CR. Clinical characteristics, pathogens implicated and therapeutic outcomes of mixed infection in adult bacterial meningitis. Kaohsiung J Med Sci 2012; 28:531-7. [PMID: 23089318 DOI: 10.1016/j.kjms.2012.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 10/31/2011] [Indexed: 11/26/2022] Open
Abstract
We reviewed retrospectively the data for adult patients with bacterial meningitis over a period of 10.5 years in our hospital. The clinical characteristics and laboratory data of the 21 cases (52 strains) of mixed infection were analyzed. Two hundred and fifteen cases of single pathogen adult bacterial meningitis (ABM) were also included for comparison. Post-neurosurgical type of ABM was presented in 86% of the mixed infection group. Brain abscess was found in three patients. Fourteen patients survived and seven cases died. The analysis showed a statistical significance for the mixed infection group having a higher rate of nosocomially-acquired, post-neurosurgical condition, hydrocephalus, and lower level of cerebrospinal fluid white cell count, protein and lactate than the single pathogen group. Logistic regression analysis showed the independent factor of "hydrocephalus" (p = 0.002). Presence of hydrocephalus is a significant neuroimaging feature when compared with the single pathogen group. As compared with the previous study results of mixed infection in ABM, the present study showed a change of pathogens implicated of increasing Pseudomonas spp. and Acinetobacter spp. infections, and an emergence of anaerobic pathogens. All these changes deserve special attention because of the need for an appropriate choice of empirical antibiotics and choice of culture method.
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Affiliation(s)
- Wan-Chen Tsai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Chen HP, Lai CH, Chan YJ, Chen TL, Liu CY, Fung CP, Liu CY. Clinical significance of Acinetobacter species isolated from cerebrospinal fluid. ACTA ACUST UNITED AC 2005; 37:669-75. [PMID: 16126568 DOI: 10.1080/00365540510044076] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Medical records of 54 patients whose cerebrospinal fluid (CSF) cultures were positive for Acinetobacter were retrospectively reviewed. In 34 (63.0%) patients, the Acinetobacter isolates were clinically insignificant. In the other 20 (37.0%) patients, presence of the organism was regarded as clinically significant and specific antimicrobial therapy was administered. Patients with clinically significant Acinetobacter in CSF more frequently resided in intensive care units (p = 0.011), had intracerebral hemorrhage (p = 0.012) or previous CNS infection (p = 0.003), had prior antibiotic exposure (p = 0.011), and had undergone neurosurgical procedures (p = 0.003). Their CSF was characteristic of neutrophilic pleocytosis, an elevated protein level, and a low CSF-to-serum glucose ratio. Apart from fever, no significant statistical differences existed in individual clinical symptoms and signs between the 2 groups of patients, while a combination of symptoms efficiently differentiated clinically significant and insignificant Acinetobacter. The finding of multiple CSF specimens positive for Acinetobacter was highly suggestive of an active CNS infection (p<0.001). The high ratio of clinically insignificant Acinetobacter CSF isolates highlights the importance of careful judgment when the organism is cultured from CSF. Antimicrobial therapy must be initiated promptly in patients with identified risk factors, while unnecessary treatment should be avoided in those without them.
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Affiliation(s)
- Hsin-Pai Chen
- Department of Medicine, Su-Ao Veterans Hospital, Yilan
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Marchandin H, Ventura V, Alonso JM, Van de Perre P. Mixed bacterial meningitis due to Streptococcus pneumoniae and Neisseria meningitidis in an 18-month-old child. J Clin Microbiol 2005; 43:1477-9. [PMID: 15750140 PMCID: PMC1081272 DOI: 10.1128/jcm.43.3.1477-1479.2005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report an unusual case of culture-proven pneumococcal and meningococcal mixed meningitis in an 18-month-old girl. The patient responded well to antimicrobial therapy and recovered completely without sequelae. No underlying condition could be demonstrated except a rhinitis of unknown etiology 2 days before the onset of the symptoms suggesting meningitis.
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Affiliation(s)
- H Marchandin
- Laboratoire de Bactériologie, Hôpital Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France.
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Pintado V, Cabellos C, Moreno S, Meseguer MA, Ayats J, Viladrich PF. Enterococcal meningitis: a clinical study of 39 cases and review of the literature. Medicine (Baltimore) 2003; 82:346-64. [PMID: 14530784 DOI: 10.1097/01.md.0000090402.56130.82] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To describe the clinical features and outcome of enterococcal meningitis, we retrospectively reviewed the charts of 39 cases seen at 2 tertiary hospitals during a 25 years and collected 101 additional, previously reported cases for review. Among these 140 cases, there were 82 cases (59%) of postoperative meningitis and 58 cases (41%) of spontaneous meningitis. Eighty-six patients (61%) were adults and 54 (39%) were children. Patients with spontaneous meningitis had a higher frequency of community-acquired infection (50% versus 18%; p < 0.01), severe underlying diseases (67% versus 22%; p < 0.01), and associated enterococcal infection (29% versus 8%; p < 0.01) than patients with postoperative meningitis. The clinical presentation was similar in both groups, but patients with spontaneous infection had a higher frequency of bacteremia (58% versus 12%; p < 0.01), and a lower frequency of mixed infection (9% versus 29%; p < 0.01). Spontaneous meningitis in children was associated with a significantly lower frequency of fever, altered mental status, headache, and meningeal signs (p < 0.01), probably explained by the high proportion of neonates in this age-group. Most infections were caused by Enterococcus faecalis, which accounted for 76% of the isolates identified at the species level. Fifteen of the 25 cases due to Enterococcus faecium were produced by vancomycin-resistant strains. Most patients were treated with ampicillin, penicillin, or vancomycin, with or without aminoglycosides, for a median period of 18 days (range, 1-85 d). Overall mortality was 21%. The mortality rate was higher in spontaneous than in postoperative meningitis (33% versus 12%; p < 0.01), but was similar in patients treated with beta-lactams (18%), glycopeptides (14%), or other antibiotics (25%), as well as in patients treated with monotherapy (16%) or combination therapy (22%). An adverse outcome correlated significantly with advanced age, the presence of severe underlying diseases, associated enterococcal infection, bacteremia, septic shock, and the absence of fever at presentation. Shunt removal was associated with a lower mortality. Multivariate analysis showed that the presence of severe underlying diseases was the only prognostic factor associated with mortality (odds ratio = 6.8, 95% confidence intervals = 2.7-17.5, p < 0.01).
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Affiliation(s)
- Vicente Pintado
- Infectious Diseases Department, Hospital Ramón y Cajal, Carretera de Colmenar km 9.1, 28034 Madrid, Spain.
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Corless CE, Guiver M, Borrow R, Edwards-Jones V, Fox AJ, Kaczmarski EB. Simultaneous detection of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae in suspected cases of meningitis and septicemia using real-time PCR. J Clin Microbiol 2001; 39:1553-8. [PMID: 11283086 PMCID: PMC87969 DOI: 10.1128/jcm.39.4.1553-1558.2001] [Citation(s) in RCA: 422] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2000] [Accepted: 01/13/2001] [Indexed: 12/16/2022] Open
Abstract
A single-tube 5' nuclease multiplex PCR assay was developed on the ABI 7700 Sequence Detection System (TaqMan) for the detection of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae from clinical samples of cerebrospinal fluid (CSF), plasma, serum, and whole blood. Capsular transport (ctrA), capsulation (bexA), and pneumolysin (ply) gene targets specific for N. meningitidis, H. influenzae, and S. pneumoniae, respectively, were selected. Using sequence-specific fluorescent-dye-labeled probes and continuous real-time monitoring, accumulation of amplified product was measured. Sensitivity was assessed using clinical samples (CSF, serum, plasma, and whole blood) from culture-confirmed cases for the three organisms. The respective sensitivities (as percentages) for N. meningitidis, H. influenzae, and S. pneumoniae were 88.4, 100, and 91.8. The primer sets were 100% specific for the selected culture isolates. The ctrA primers amplified meningococcal serogroups A, B, C, 29E, W135, X, Y, and Z; the ply primers amplified pneumococcal serotypes 1, 2, 3, 4, 5, 6, 7, 8, 9, 10A, 11A, 12, 14, 15B, 17F, 18C, 19, 20, 22, 23, 24, 31, and 33; and the bexA primers amplified H. influenzae types b and c. Coamplification of two target genes without a loss of sensitivity was demonstrated. The multiplex assay was then used to test a large number (n = 4,113) of culture-negative samples for the three pathogens. Cases of meningococcal, H. influenzae, and pneumococcal disease that had not previously been confirmed by culture were identified with this assay. The ctrA primer set used in the multiplex PCR was found to be more sensitive (P < 0.0001) than the ctrA primers that had been used for meningococcal PCR testing at that time.
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MESH Headings
- ATP-Binding Cassette Transporters
- Bacteremia/diagnosis
- Bacteremia/microbiology
- Bacterial Proteins/genetics
- Culture Media
- DNA Primers
- DNA, Bacterial/blood
- DNA, Bacterial/cerebrospinal fluid
- DNA-Binding Proteins
- Haemophilus influenzae/genetics
- Haemophilus influenzae/isolation & purification
- Humans
- Meningitis, Bacterial/diagnosis
- Meningitis, Bacterial/microbiology
- Meningitis, Haemophilus/diagnosis
- Meningitis, Haemophilus/microbiology
- Meningitis, Meningococcal/diagnosis
- Meningitis, Meningococcal/microbiology
- Meningitis, Pneumococcal/diagnosis
- Meningitis, Pneumococcal/microbiology
- Molecular Sequence Data
- Neisseria meningitidis/genetics
- Neisseria meningitidis/isolation & purification
- Polymerase Chain Reaction/methods
- Sensitivity and Specificity
- Streptococcus pneumoniae/genetics
- Streptococcus pneumoniae/isolation & purification
- Streptolysins/genetics
- Taq Polymerase/metabolism
- Transcription Factors
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Affiliation(s)
- C E Corless
- Meningococcal Reference Unit, Manchester Public Health Laboratory, Withington Hospital, Manchester M20 2LR, United Kingdom
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Tang LM, Chen ST. Klebsiella oxytoca meningitis: frequent association with neurosurgical procedures. Infection 1995; 23:163-7. [PMID: 7499005 DOI: 10.1007/bf01793857] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Klebsiella oxytoca meningitis is a rare condition. Nine patients were diagnosed between 1981 and 1993 at our institution. These accounted for 2.3% of 393 patients with blood and/or cerebrospinal fluid culture-proven bacterial meningitis. K. oxytoca was noted in both community-acquired meningitis and nosocomial meningitis. Eight of the nine cases were patients who had undergone neurosurgical procedures. Four were mixed bacterial meningitis. All K. oxytoca isolates were susceptible to third-generation cephalosporins and all but one to chloramphenicol. Antibiotic therapy was successful in eight patients but failed in one.
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Affiliation(s)
- L M Tang
- Dept. of Neurology, Chang Gung Memorial Hospital and Medical College, Taipei, Taiwan
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Abstract
Citrobacter meningitis is an uncommon infection of neonates and young children. It is rarely seen in adults. We describe a 46-year-old man with a mixed bacterial meningitis caused by C. diversus and Klebsiella oxytoca and a 64-year-old woman with C. freundii meningitis. Review of the English-language literature revealed only 2 adult patients with C. diversus meningitis and another 2, with C. freundii meningitis. The ages of these 6 aforementioned patients ranged from 31 to 84 years. Multiple facial fractures, neurosurgical procedures, alcoholism and diabetes mellitus were predisposing conditions. Among the 5 patients whose outcome was known, antibiotic therapy was successful in 4 but failed in 1. This study emphasizes that almost any of the gram-negative bacilli can cause serious infection of the central nervous system in adults in the proper setting.
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Affiliation(s)
- L M Tang
- Department of Neurology, Chang Gung Memorial Hospital and Chang Gung Medical College, Taipei, Taiwan
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Affiliation(s)
- M Anderson
- Midland Centre for Neurosurgery and Neurology, Smethwick, Warley, West Midlands
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Zabinski RA, Vance-Bryan K, Rotschafer JC. The Management of Central Nervous System Infections. J Pharm Pract 1991. [DOI: 10.1177/089719009100400304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Richard A. Zabinski
- Section of Clinical Pharmacology; St Paul-Ramsey Medical Center, 640 Jackson St, St Paul, MN 55101
| | - Kyle Vance-Bryan
- From the Section of Clinical Pharmacology, St Paul-Ramsey Medical Center, St Paul, MN, Department of Pharmacy Practice, College of Pharmacy, University of Minnesota, Minneapolis, MN
| | - John C. Rotschafer
- From the Section of Clinical Pharmacology, St Paul-Ramsey Medical Center, St Paul, MN, Department of Pharmacy Practice, College of Pharmacy, University of Minnesota, Minneapolis, MN
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Jensen ANNETTE, Kjaeldgaard POUL, Lukman BERIT, Overgaard SØREN. Mixed bacterial meningitis in an adult caused byHaemophilus influenzaeandStreptococcus pneumoniae. APMIS 1990. [DOI: 10.1111/j.1699-0463.1990.tb01010.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Roos KL, Scheld WM. The Management of Fulminant Meningitis in the Intensive Care Unit. Infect Dis Clin North Am 1989. [DOI: 10.1016/s0891-5520(20)30250-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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