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Garcia R, Jiménez-Valera M, Ruiz-Buck D, Sanchez C, Rojas A, Schütz MH, Rojas J, Hunfeld KP. Detection of intrathecal IgG antibody for varicella and measles diagnosis by evaluation and comparison of a commercial IgG chemiluminescent immunoassay with two ELISAs. Eur J Clin Microbiol Infect Dis 2024:10.1007/s10096-024-04822-x. [PMID: 38613705 DOI: 10.1007/s10096-024-04822-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/26/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVES Analyse alternative methods of intrathecal antibody detection by comparing chemiluminescent immunoassay (CLIA) and enzyme-linked immunosorbent assay (ELISA) techniques to determine if CLIA can replace ELISA in the diagnosis of CNS infections. METHODS A panel of 280 paired samples-cerebrospinal fluid (CSF) and serum-with known antibody reactivities (Varicella, n = 60; Measles, n = 120) and negative samples (n = 100) were used to evaluate the performance of six serological test kits (Enzygnost, VirClia®, and Serion ELISA (Measles and Variella). RESULTS For Measles virus IgG, the VirClia® IgG monotest revealed 97% and 94% positive and negative agreement to the Enzygnost as reference test, respectively. In contrast, Serion ELISA kits yielded values of 18% and 90%. For the Varicella Zoster virus (VZV) IgG, the VirClia® IgG monotest showed 97% and 90% positive and negative agreement compared to Enzygnost. The Serion ELISA kits showed values of 55% and 86%, respectively. ROC analysis revealed that the areas under the curve for Measles and VZV IgGs were 0.7 and 0.852, respectively, using the Serion kit, and 0.963 and 0.955, for Vircell S.L CLIA technique. VirClia® monotest values were calculated using an antibody index cut-off of 1.3. CONCLUSION The findings indicate that CLIA testing can improve antibody detection in CSF samples, aiding the diagnosis of infectious neurological impairments.
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Affiliation(s)
- Rafael Garcia
- Vircell S.L., Parque Tecnológico de la Salud, C/ Avicena, 8, 18016, Granada, Spain.
| | - Maria Jiménez-Valera
- Department of Microbiology, Faculty of Pharmacy, University of Granada, Granada, Spain
| | - Daniel Ruiz-Buck
- Vircell S.L., Parque Tecnológico de la Salud, C/ Avicena, 8, 18016, Granada, Spain
| | - Carlos Sanchez
- Vircell S.L., Parque Tecnológico de la Salud, C/ Avicena, 8, 18016, Granada, Spain
| | - Almudena Rojas
- Vircell S.L., Parque Tecnológico de la Salud, C/ Avicena, 8, 18016, Granada, Spain
| | - Malte Hendrik Schütz
- Institute for Laboratory Medicine, Medical Microbiology and Infection Control, Northwest Medical Centre, Medical Faculty, Academic Teaching Hospital, Goethe-University, Frankfurt am Main, Germany
| | - Jose Rojas
- Vircell S.L., Parque Tecnológico de la Salud, C/ Avicena, 8, 18016, Granada, Spain
| | - Klaus- Peter Hunfeld
- Institute for Laboratory Medicine, Medical Microbiology and Infection Control, Northwest Medical Centre, Medical Faculty, Academic Teaching Hospital, Goethe-University, Frankfurt am Main, Germany
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Puccioni-Sohler M, Nascimento Soares C, Christo PP, Almeida SMD. Review of dengue, zika and chikungunya infections in nervous system in endemic areas. Arq Neuropsiquiatr 2023; 81:1112-1124. [PMID: 38157877 PMCID: PMC10756841 DOI: 10.1055/s-0043-1777104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/15/2023] [Indexed: 01/03/2024]
Abstract
Dengue, zika, and chikungunya are arboviruses of great epidemiological relevance worldwide. The emergence and re-emergence of viral infections transmitted by mosquitoes constitute a serious human public health problem. The neurological manifestations caused by these viruses have a high potential for death or sequelae. The complications that occur in the nervous system associated with arboviruses can be a challenge for diagnosis and treatment. In endemic areas, suspected cases should include acute encephalitis, myelitis, encephalomyelitis, polyradiculoneuritis, and/or other syndromes of the central or peripheral nervous system, in the absence of a known explanation. The confirmation diagnosis is based on viral (isolation or RT-PCR) or antigens detection in tissues, blood, cerebrospinal fluid, or other body fluids, increase in IgG antibody titers between paired serum samples, specific IgM antibody in cerebrospinal fluid and serological conversion to IgM between paired serum samples (non-reactive in the acute phase and reactive in the convalescent). The cerebrospinal fluid examination can demonstrate: 1. etiological agent; 2. inflammatory reaction or protein-cytological dissociation depending on the neurological condition; 3. specific IgM, 4. intrathecal synthesis of specific IgG (dengue and chikungunya); 5. exclusion of other infectious agents. The treatment of neurological complications aims to improve the symptoms, while the vaccine represents the great hope for the control and prevention of neuroinvasive arboviruses. This narrative review summarizes the updated epidemiology, general features, neuropathogenesis, and neurological manifestations associated with dengue, zika, and chikungunya infection.
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Affiliation(s)
- Marzia Puccioni-Sohler
- Universidade Federal do Estado do Rio de Janeiro, Escola de Medicina e Cirurgia, Departamento de Medicina Geral, Rio de Janeiro RJ, Brazil.
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Rio de Janeiro RJ, Brazil.
| | | | - Paulo Pereira Christo
- Santa Casa BH, Faculdade de Saúde, Programa de Pós-Graduação Stricto Sensu em Medicina-Biomedicina, Belo Horizonte MG, Brazil.
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Neurologia, Belo Horizonte MG, Brazil.
| | - Sérgio Monteiro de Almeida
- Universidade Federal do Paraná, Faculdade de Medicina, Departamento de Patologia Médica, Curitiba PR, Brazil.
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Klein M, Abdel-Hadi C, Bühler R, Grabein B, Linn J, Nau R, Salzberger B, Schlüter D, Schwager K, Tumani H, Weber J, Pfister HW. German guidelines on community-acquired acute bacterial meningitis in adults. Neurol Res Pract 2023; 5:44. [PMID: 37649122 PMCID: PMC10470134 DOI: 10.1186/s42466-023-00264-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION The incidence of community-acquired acute bacterial meningitis has decreased during the last decades. However, outcome remains poor with a significant proportion of patients not surviving and up to 50% of survivors suffering from long-term sequelae. These guidelines were developed by the Deutsche Gesellschaft für Neurologie (DGN) under guidance of the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) to guide physicians through diagnostics and treatment of adult patients with acute bacterial meningitis. RECOMMENDATIONS The most important recommendations are: (i) In patients with suspected acute bacterial meningitis, we recommend that lumbar cerebrospinal fluid (with simultaneous collection of serum to determine the cerebrospinal fluid-serum glucose index and blood cultures) is obtained immediately after the clinical examination (in the absence of severely impaired consciousness, focal neurological deficits, and/or new epileptic seizures). (ii) Next, we recommend application of dexamethasone and empiric antibiotics intravenously. (iii) The recommended initial empiric antibiotic regimen consists of ampicillin and a group 3a cephalosporin (e.g., ceftriaxone). (iv) In patients with severely impaired consciousness, new onset focal neurological deficits (e.g. hemiparesis) and/or patients with newly occurring epileptic seizures, we recommend that dexamethasone and antibiotics are started immediately after the collection of blood; we further recommend that -if the imaging findings do not indicate otherwise -a lumbar CSF sample is taken directly after imaging. (v) Due to the frequent occurrence of intracranial and systemic complications, we suggest that patients with acute bacterial meningitis are treated at an intensive care unit in the initial phase of the disease. In the case of impaired consciousness, we suggest that this is done at an intensive care unit with experience in the treatment of patients with severe CNS diseases. CONCLUSIONS The German S2k-guidelines give up to date recommendations for workup, diagnostics and treatment in adult patients with acute bacterial meningitis.
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Affiliation(s)
- Matthias Klein
- Department of Neurology, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany
- Emergency Department, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany
| | | | - Robert Bühler
- Department of Neurology, Bürgerspital, Solothurn, Switzerland
| | - Beatrice Grabein
- Klinische Mikrobiologie und Krankenhaushygiene, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany
| | - Jennifer Linn
- Department of Diagnostic and Interventional Neuroradiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Roland Nau
- Department of Neuropathology, Evangelisches Krankenhaus Göttingen-Weende, Georg-August-University, Göttingen, Göttingen, Germany
| | - Bernd Salzberger
- Klinik und Poliklinik für Innere Medizin, University of Regensburg, Regensburg, Germany
| | - Dirk Schlüter
- Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule, Hannover, Germany
| | - Konrad Schwager
- Klinik für Hals-Nasen-Ohrenkrankheiten, Kopf- Hals- und plastische Gesichtschirurgie, Kommunikationsstörungen, Fulda, Germany
| | - Hayrettin Tumani
- Labor für Liquordiagnostik, Neurologische Universitätsklinik Ulm, University of Ulm, Ulm, Germany
| | - Jörg Weber
- Department of Neurology, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Hans-Walter Pfister
- Department of Neurology, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany
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de Almeida SM, Castoldi JR, Riechi SC. Comparison between cerebrospinal fluid biomarkers for differential diagnosis of acute meningitis. Diagnosis (Berl) 2023; 10:298-308. [PMID: 37023413 DOI: 10.1515/dx-2023-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/23/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVES Given the difficulty in the differential diagnosis of acute bacterial meningitis (BM) and viral meningitis (VM), we aimed to compare the ability of cerebrospinal fluid (CSF) biomarkers, such as lactate, glucose, lactate dehydrogenase (LDH), C-reactive protein (CRP), total white blood cell count, and predominance of neutrophils, as single tests to differentiate microbiologically defined acute BM and VM. METHODS CSF samples were divided into three groups: BM (n=17), VM (n=14) (both with the etiological agent identified), and normal control groups (n=26). RESULTS All the biomarkers studied were significantly higher in the BM group than in the VM or control groups (p>0.05). CSF lactate showed the best diagnostic clinical performance characteristics: sensitivity (94.12%), specificity (100%), positive and negative predictive value (100 and 97.56%, respectively), positive and negative likelihood ratio (38.59 and 0.06, respectively), accuracy (98.25%), and AUC (0.97). CSF CRP is excellent for screening BM and VM, as its best feature is its specificity (100%). CSF LDH is not recommended for screening or case-finding. LDH levels were higher in Gram-negative diplococcus than in Gram-positive diplococcus. Other biomarkers were not different between Gram-positive and negative bacteria. The highest level of agreement between the CSF biomarkers was between CSF lactate and CRP [kappa coefficient, 0.91 (0.79; 1.00)]. CONCLUSIONS All markers showed significant differences between the studied groups and were increased in acute BM. CSF lactate is better than the other biomarkers studied for screening acute BM due to its high specificity.
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Affiliation(s)
- Sérgio Monteiro de Almeida
- Clinical Laboratory, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
- Neuroinfection Outclinic, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Juliane Rosa Castoldi
- Clinical Laboratory, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Salomão Cury Riechi
- Clinical Laboratory, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
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Kazancioglu S, Bastug A, Ozbay BO, Tezcan H, Buyuktarakci C, Akbay A, Bodur H. The usefulness of hematological parameters and cerebrospinal fluid indexes in the differential diagnosis of acute bacterial from viral meningitis. Diagn Microbiol Infect Dis 2023; 107:116005. [PMID: 37392600 DOI: 10.1016/j.diagmicrobio.2023.116005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/19/2023] [Accepted: 06/07/2023] [Indexed: 07/03/2023]
Abstract
Central nervous system (CNS) infection is a medical emergency with an important cause of mortality worldwide. The 79 patients with confirmed acute CNS infection (48 bacterial and 31 viral meningitis) were evaluated. Bacterial meningitis score, cerebrospinal fluid (CSF)/serum glucose ratio, and CSF/serum albumin ratio had the highest area under the curves (0.873, 0.843, 0.810, respectively) for discriminating bacterial meningitis. Neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte ratio (PLR) and CSF lactate dehydrogenase have a good ability for the differential diagnosis of bacterial meningitis. CSF/serum glucose ratio, NLR (with a cut-off value> 8.87), large unstained cell, total protein, albumin, and procalcitonin levels were found to be predictors for mortality. NLR can be used as a biomarker to differentiate bacterial meningitis from viral meningitis and to predict the prognosis of CNS infection. CSF/serum albumin ratio and CSF lactate dehydrogenase can be used to predict bacterial meningitis as well as CSF/serum glucose ratio.
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Affiliation(s)
- Sumeyye Kazancioglu
- Ministry of Health Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
| | - Aliye Bastug
- Health Science University Turkey, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Bahadir Orkun Ozbay
- Ministry of Health Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Hatice Tezcan
- Ministry of Health Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Cansu Buyuktarakci
- Ministry of Health Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Aysenur Akbay
- Ministry of Health Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Hurrem Bodur
- Health Science University Turkey, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
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de Almeida SM, Kussen GB, Cogo LL, Nogueira K. Cerebrospinal fluid lactate as a predictive biomarker for tuberculous meningitis diagnosis. Diagnosis (Berl) 2022; 10:130-139. [PMID: 36476307 DOI: 10.1515/dx-2022-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
Abstract
Objectives
The definitive diagnosis of tuberculous meningitis (TBM) is achieved by identifying Mycobacterium tuberculosis (MTb) in cerebrospinal fluid (CSF); however, diagnostic confirmation is difficult due to the inability of current tests for an effective diagnosis. Our objective was to retrospectively assess the characteristics of CSF lactate (CSF-LA) as an adjunct biomarker in the diagnosis of TBM.
Methods
608 CSF laboratory reports were assessed. Of these, 560 had clinically suspected TBM. These were classified as definite (n=36), probable (23), possible (278), or non-TBM (223) according to the international consensus TBM case definitions. An additional 48 CSF samples were negative controls with normal CSF.
Results
Against a reference standard of definite TBM, the cut-off value for CSF-LA was 4.0 mmol/L, the area under the ROC curve was 0.88 (95% CI, 0.82–0.94; p=0.0001), sensitivity was 69%, specificity 90%, negative predictive value 98%. These diagnostic parameters decreased when calculated against those of the other categories of TBM. CSF-LA exhibited high specificity, efficiency, negative predictive value, and clinical utility index in all the groups studied.
Conclusions
CSF-LA is a useful diagnostic marker to rule out TBM when associated with conventional microbiology tests, nucleic acid amplification assays, and clinical algorithms, particularly in endemic areas.
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Affiliation(s)
- Sérgio Monteiro de Almeida
- Virology Section Clinical Pathology Laboratory Hospital De Clínicas , Federal University of Paraná , Curitiba , Brazil
- CSF Section Clinical Pathology Laboratory Hospital De Clínicas , Federal University of Paraná , Curitiba , Brazil
| | - Gislene B. Kussen
- Bacteriology Section, Clinical Pathology Laboratory, Hospital De Clínicas , Federal University of Paraná , Curitiba , Brazil
| | - Laura L. Cogo
- Bacteriology Section, Clinical Pathology Laboratory, Hospital De Clínicas , Federal University of Paraná , Curitiba , Brazil
| | - Keite Nogueira
- Bacteriology Section, Clinical Pathology Laboratory, Hospital De Clínicas , Federal University of Paraná , Curitiba , Brazil
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Lin GYE, Lin CY, Chi H, Huang DTN, Huang CY, Chiu NC. The experience of using FilmArray Meningitis/Encephalitis Panel for the diagnosis of meningitis and encephalitis in pediatric patients. J Microbiol Immunol Infect 2022; 55:1180-1187. [PMID: 35987724 DOI: 10.1016/j.jmii.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 07/02/2022] [Accepted: 07/30/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND/PURPOSE Central nervous system infections can cause severe complications and even death in children. Early diagnosis of the causative pathogen can guide appropriate treatment and improve outcomes. The BioFire® FilmArray® Meningitis/Encephalitis Panel (FA-ME) is a multiplex polymerase chain reaction (PCR) assay targeting 14 pathogens. We aimed to examine FA-ME performance compared with conventional assays and its effect on antimicrobial usage. METHODS We prospectively enrolled 55 pediatric patients with suspected meningitis or encephalitis and simultaneously performed FA-ME and conventional assays. Sixty-three hospitalized patients with CNS infection before implementing FA-ME were considered controls. We compared the FA-ME results with conventional assays and the empiric antimicrobial usage and hospital stay between the two study groups. RESULTS Nine patients (16.4%) tested positive by FA-ME, four were bacterial, and five were viral. Three additional pathogens were detected by conventional assays: Enterococcus faecalis, Leptospira, and herpes simplex virus type 2. In the control group, two bacterial pathogens were detected by CSF culture and four viral pathogens by single PCRs. Compared with the control group, the FA-ME group had a shorter time for pathogen detection, but there were no significant differences in pathogen detection rate, duration of empiric antimicrobial therapy, and length of hospital stay. CONCLUSION Although no significant difference was found in empiric antimicrobial duration and length of stay between patients tested with FA-ME and conventional assays, FA-ME had the advantage of a shorter detection time and early exclusion of potential causative pathogens. The FA-ME results should be interpreted carefully based on the clinical presentation.
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Affiliation(s)
- Grace Yong-En Lin
- Department of Pediatric Infectious Diseases, MacKay Children's Hospital, Taipei, Taiwan; Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.
| | - Chien-Yu Lin
- Department of Medicine, MacKay Medicine College, New Taipei, Taiwan; Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.
| | - Hsin Chi
- Department of Pediatric Infectious Diseases, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medicine College, New Taipei, Taiwan.
| | - Daniel Tsung-Ning Huang
- Department of Pediatric Infectious Diseases, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medicine College, New Taipei, Taiwan.
| | - Ching-Ying Huang
- Department of Pediatric Infectious Diseases, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medicine College, New Taipei, Taiwan.
| | - Nan-Chang Chiu
- Department of Pediatric Infectious Diseases, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medicine College, New Taipei, Taiwan.
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Çakırlar FK. Application of Biomarkers in the Diagnostic Distinction of Bacterial and Viral Infections. Biomark Med 2022. [DOI: 10.2174/9789815040463122010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Infectious diseases, which pose a great threat worldwide, have a significant
impact on public health and the world economy. It contributes to increased healthcare
costs, unnecessary drug-related side effects, and increased antimicrobial resistance. It is
not always easy to distinguish the etiological differentiation of diseases that can
develop with bacteria and viruses. Therefore, one of the biggest challenges in medicine
is how to correctly distinguish between the different causes of these infections and how
to manage the patient. Because bacterial and viral infections often present similar
symptoms. The real decision is whether the infection is caused by bacteria or viruses
and whether to treat the patient with antibiotics. There are many different
methodological approaches to diagnosing infections. Biomarkers have been used in the
diagnosis of diseases and other conditions for many years. Biomarkers are molecules
found in blood and body fluids in measurable amounts, which can evaluate biological
and pathological processes. These key indicators can provide vital information in
determining disease prognosis, predicting response to treatments, adverse events and
drug interactions, and identifying key risks. An effective biomarker is extremely
important for the early diagnosis of various diseases. The explosion of interest in
biomarker research is driving the development of new predictive, diagnostic, and
prognostic products in modern medical practice. The purpose of this review is to
demonstrate the use and diagnostic potential of current and investigational biomarkers
in the distinction between bacterial and viral infections.
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Affiliation(s)
- Fatma Köksal Çakırlar
- Faculty of Cerrahpaşa Medicine, University of İstanbul- Cerrahpaşa,Department of Medical Microbiology,Department of Medical Microbiology, Faculty of Cerrahpaşa Medicine, University of İstanbul- Cerrahpaşa, Istanbul, Turkey,Istanbul,Turkey
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Obreja M, Miftode EG, Stoleriu I, Constantinescu D, Vâță A, Leca D, Cianga CM, Dorneanu OS, Pavel-Tanasa M, Cianga P. Heparin-Binding Protein (HBP), Neutrophil Gelatinase-Associated Lipocalin (NGAL) and S100 Calcium-Binding Protein B (S100B) Can Confirm Bacterial Meningitis and Inform Adequate Antibiotic Treatment. Antibiotics (Basel) 2022; 11. [PMID: 35740230 DOI: 10.3390/antibiotics11060824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/11/2022] [Accepted: 06/16/2022] [Indexed: 01/27/2023] Open
Abstract
The empirical administration of antibiotics for suspected bacterial meningitis denotes a poor bacterial stewardship. In this context, the use of biomarkers can distinguish between bacterial and viral infections before deciding treatment. Our study assesses how levels of heparin-binding protein (HBP), neutrophil gelatinase-associated lipocalin (NGAL), S100 calcium-binding protein B (S100B), and neuron-specific enolase (NSE) in cerebrospinal fluid (CSF) and in blood can promptly confirm bacterial etiology and the need for antibiotic treatment. The CSF and blood levels of HBP, NGAL, S100B, and NSE of 81 patients with meningitis were measured and analyzed comparatively. Statistical sensitivity, specificity, and positive and negative predictive values were evaluated. CSF levels of HBP and NGAL and the blood level of S100B in the bacterial meningitis group were significantly higher (p < 0.05). The area under curve (AUC) for predicting bacterial meningitis was excellent for the CSF level of HBP (0.808 with 93.54% sensitivity and 80.64% specificity), good for the CSF level of NGAL (0.685 with 75.00% sensitivity and 65.62% specificity), and good for the blood level of S100B (0.652 with 65.90% sensitivity and 57.14% specificity). CSF levels of HBP and NGAL, as well as the blood level of S100B, could help discriminate between bacterial and viral meningitis before considering antibiotic treatment.
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de Almeida SM, Barros N, Fernandes Dos Santos A, Custodio G, Petterle RR, Nogueira K, Nogueira MB. Clinical performance of amperometry compared with enzymatic ultra violet method for lactate quantification in cerebrospinal fluid. Diagnosis (Berl) 2021; 8:510-514. [PMID: 32857713 DOI: 10.1515/dx-2020-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/13/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The differential diagnosis between acute bacterial meningitis (BM) and viral meningitis (VM) is crucial for treatment and prognosis. Cerebrospinal fluid (CSF) lactate (LA) is considered a good biomarker for differentiating BM from VM. The objective of this study was to compare the clinical performance of amperometry, which is not validated for measurement of LA in CSF samples, with a validated method (enzymatic ultra violet), for their ability to discriminate between acute BM and VM. METHODS It was a retrospective, descriptive comparative study, 320 CSF reports were included; LA was quantified in CSF using either Dimension AR machine (Dade Behring) or amperometry (RAPID Point 500, Siemens). All samples with bacteria (n=54) or virus (n=139) identified, compared with a control with normal CSF (n=127). RESULTS CSF LA levels were comparable for amperometry or enzymatic methods on each group studied, in a wide range of LA levels; it was capable to distinguish BM from VM independent of the method used to quantify. CONCLUSIONS The findings support the use of the amperometric method in measuring LA concentrations in CSF in a wide range of values. Amperometry is a less expensive method, validated for blood, easily available in small laboratories including in limited resources countries.
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Affiliation(s)
| | - Nagyla Barros
- Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | | | - Gislaine Custodio
- Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | | | - Keite Nogueira
- Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
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11
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Liu X, Liu X, Lin S, Du K, Ai Y, Wang Y. Procalcitonin measurement using antibody-conjugated fluorescent microspheres distinguishes atypical bacterial meningitis from viral encephalitis in children. Anal Biochem 2021; 626:114219. [PMID: 33930346 DOI: 10.1016/j.ab.2021.114219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/01/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022]
Abstract
Examination of cerebrospinal fluid in atypical bacterial meningitis (ABM) is similar to that of viral encephalitis (VE), so ABM can easily be misdiagnosed as VE, which can delay diagnosis and treatment. We developed a simple, rapid hand-held lateral flow immunoassay detection system based on fluorescent microspheres (FMS) for procalcitonin (PCT) detection, which provides an indicator to differentiate between ABM and VE. With this novel method, the antigen-antibody reaction systems involve different species, making the test strips more stable than those utilizing one species. The strips exhibited a wide dynamic range (0.04-50 ng/mL) and good sensitivity (0.03 ng/mL). The function of PCT in the identification of ABM and VE in children was further studied. A significant difference in PCT levels was observed between the ABM and VE groups (P = 0.00) and between the ABM and the normal control groups (P = 0.00). PCT levels were not significantly different between the VE and normal control groups (P = 0.30). The area under the receiver operating characteristic curve of PCT for the diagnosis of ABM was 0.95. These findings collectively indicate the usefulness of the PCT detection method based on FMS for clinically differentiating between ABM and VE.
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Affiliation(s)
- Xinquan Liu
- School of Precision Instrument and Optoelectronics Engineering, Tianjin University, Tianjin, 300072, China.
| | - Xingmiao Liu
- Department of Pediatric Neurology, Tianjin Children's Hospital, Tianjin, 300074, China
| | - Si Lin
- School of Precision Instrument and Optoelectronics Engineering, Tianjin University, Tianjin, 300072, China
| | - Kang Du
- School of Precision Instrument and Optoelectronics Engineering, Tianjin University, Tianjin, 300072, China
| | - Yu Ai
- Tianjin Boomscience Technology Co., Ltd., Tianjin, 300401, China
| | - Yan Wang
- School of Precision Instrument and Optoelectronics Engineering, Tianjin University, Tianjin, 300072, China.
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Ahlawat S, Chaudhary R, Dangi M, Bala K, Singh M, Chhillar AK. Advances in tuberculous meningitis diagnosis. Expert Rev Mol Diagn 2020; 20:1229-1241. [PMID: 33259249 DOI: 10.1080/14737159.2020.1858805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Tuberculous meningitis (TBM) is the most devastating form of central nervous system tuberculosis (TB) and causes high mortality worldwide. Nonspecific clinical manifestations and limited sensitivity of existing laboratory methods make the diagnosis elusive due to the paucibacillary nature of the infection. Areas Covered: We reviewed current literature on the adequacy and limitations of globally existing laboratory methods for diagnosing TBM. Expert opinion: TBM is deadliest among all TB forms, as the outcome may lead to death in 50% of cases, and survivors undergo irreversible neurological disorders. Therefore, early diagnosis and prompt treatment are cornerstones of effective disease management. Conventional microscopy and culture are widely used modalities but remain inadequate in most TBM cases. Although expanded use of rapid molecular tests such as real-time PCR and Xpert Ultra, even in resource-limited settings, hold promising results for TB diagnosis but need optimization for early detection of TBM. Moreover, CSF IGRA is also used but unable to differentiate between active and latent TB. Overall no single test for diagnosing TBM has adequate accuracy so, there is an urgent need to devise a point-of-care test.
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Affiliation(s)
- Sonia Ahlawat
- Centre for Biotechnology, Maharshi Dayanand University (MDU) , Rohtak, India.,Amity Institute of Biotechnology, Amity University Haryana , Manesar, India
| | - Renu Chaudhary
- Council of Scientific & Industrial Research (CSIR)-institute of Genomics and Integrative Biology (IGIB) , New Delhi, India
| | - Mehak Dangi
- Department of Bioinformatics, Maharshi Dayanand University (MDU) , Rohtak, India
| | - Kiran Bala
- Department of Neurology, University of Health Sciences (UHS) , Rohtak, India
| | - Machiavelli Singh
- Amity Institute of Biotechnology, Amity University Haryana , Manesar, India
| | - Anil Kumar Chhillar
- Centre for Biotechnology, Maharshi Dayanand University (MDU) , Rohtak, India
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