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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: 1] [Impact Index Per Article: 1.0] [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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Xirogianni A, Georgakopoulou T, Patsourakos V, Magaziotou I, Papandreou A, Simantirakis S, Tzanakaki G. Impact of a Single-Tube PCR Assay for the Detection of Haemophilus influenzae Serotypes a, c, d, e and f on the Epidemiological Surveillance in Greece. Microorganisms 2022; 10:microorganisms10071367. [PMID: 35889086 PMCID: PMC9322709 DOI: 10.3390/microorganisms10071367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 12/07/2022] Open
Abstract
Background: The decrease in the rate of meningitis due to Haemophilus influenzae type b after vaccine introduction and a possible change in epidemiology of H. influenzae disease highlights the need for continuous serotype surveillance. Methods: A single-tube multiplex PCR assay for serotyping of H. influenzae was developed and deployed. Results: During 2003−2020, 108 meningitis cases due to H. influenzae were notified; 86 (80%) were confirmed and serotyped by molecular methods. The overall specificity and sensitivity of the assay were estimated (100% PPV and NPV respectively). The overall mean annual reported incidence for H. influenzae was 0.02, while for Hib and non-b meningitis equaled 0.02 and 0.03 per 100 000, respectively. Analysis by age group revealed that H. influenzae peaks in toddlers and children 0−4 years and in adults >45 years old. Among the serotyped cases, 39.8% were identified as Hib, 46.3% as NTHi, and 0.9% and 2.8% as serotypes a (Hia) and f (Hif)) respectively. Conclusions: Low incidence due to Hib was observed while non-typeable H. influenzae (NTHi) and serotypes Hia and Hif seem to emerge. The application of the current assay discloses the ongoing change of invasive H. influenzae disease trends during the Hib post-vaccine era.
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Affiliation(s)
- Athanasia Xirogianni
- National Meningitis Reference Laboratory, Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens, Greece; (A.X.); (V.P.); (A.P.); (S.S.)
| | - Theano Georgakopoulou
- Department of Vaccine Preventable Diseases, National Public Health Organization (NPHO), 15123 Athens, Greece; (T.G.); (I.M.)
| | - Vassileios Patsourakos
- National Meningitis Reference Laboratory, Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens, Greece; (A.X.); (V.P.); (A.P.); (S.S.)
| | - Ioanna Magaziotou
- Department of Vaccine Preventable Diseases, National Public Health Organization (NPHO), 15123 Athens, Greece; (T.G.); (I.M.)
| | - Anastasia Papandreou
- National Meningitis Reference Laboratory, Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens, Greece; (A.X.); (V.P.); (A.P.); (S.S.)
| | - Stelmos Simantirakis
- National Meningitis Reference Laboratory, Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens, Greece; (A.X.); (V.P.); (A.P.); (S.S.)
| | - Georgina Tzanakaki
- National Meningitis Reference Laboratory, Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens, Greece; (A.X.); (V.P.); (A.P.); (S.S.)
- Correspondence: ; Tel.: +30-213-20-10-267
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Hemmati N, Nikkhahi F, Javadi A, Eskandarion S, Marashi SMA. Use of a new multiplex quantitative polymerase chain reaction based assay for simultaneous detection of Neisseria meningitidis, Escherichia coli K1 , Streptococcus agalactiae, and Streptococcus pneumoniae. IRANIAN JOURNAL OF MICROBIOLOGY 2021; 13:464-469. [PMID: 34557274 PMCID: PMC8421586 DOI: 10.18502/ijm.v13i4.6970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background and Objectives Neisseria meningitidis, Escherichia coli K1, Streptococcus agalactiae, and Streptococcus pneumoniae cause 90% of bacterial meningitis. Almost all infected people die or have irreversible neurological complications. Therefore, it is essential to have a diagnostic kit with the ability to quickly detect these fatal infections. Materials and Methods The project involved 212 patients from whom cerebrospinal fluid samples were obtained. After total genome extraction and performing multiplex quantitative polymerase chain reaction (qPCR), the presence or absence of each infectious factor was determined by comparing with standard strains. Results The specificity, sensitivity, positive predictive value, and negative predictive value calculated were 100%, 92.9%, 50%, and 100%, respectively. So, due to the high specificity and sensitivity of the designed primers, they can be used instead of bacterial culture that takes at least 24 to 48 hours. Conclusion The remarkable benefit of this method is associated with the speed (up to 3 hours) at which the procedure could be completed. It is also worth noting that this method can reduce the personnel unintentional errors which may occur in the laboratory. On the other hand, as this method simultaneously identifies four common factors that cause bacterial meningitis, it could be used as an auxiliary method diagnostic technique in laboratories particularly in cases of emergency medicine.
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Affiliation(s)
- Nastaran Hemmati
- Student Research Committee, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Farhad Nikkhahi
- Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Amir Javadi
- Department of Community Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Sahar Eskandarion
- Department of Pediatric Medicine, Imam Hossein Hospital, Iran University of Medical Sciences, Tehran, Iran
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BOCCALINI SARA, PANATTO DONATELLA, MENNINI FRANCESCOSAVERIO, MARCELLUSI ANDREA, BINI CHIARA, AMICIZIA DANIELA, LAI PIEROLUIGI, MICALE ROSANNATINDARA, FRUMENTO DAVIDE, AZZARI CHIARA, RICCI SILVIA, BONITO BENEDETTA, DI PISA GIULIA, IOVINE MARIASILVIA, LODI LORENZO, GIOVANNINI MATTIA, MOSCADELLI ANDREA, PAOLI SONIA, PENNATI BEATRICEMARINA, PISANO LAURA, BECHINI ANGELA, BONANNI PAOLO. [ Health Technology Assessment (HTA) of the introduction of additional cohorts for anti-meningococcal vaccination with quadrivalent conjugate vaccines in Italy]. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E1-E128. [PMID: 34622076 PMCID: PMC8452280 DOI: 10.15167/2421-4248/jpmh2021.62.1s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- SARA BOCCALINI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
- Autore corrispondente: Sara Boccalini, Dipartimento di Scienze della Salute, Università degli Studi di Firenze, 50134 Firenze, Italia - Tel.: 055-2751084 E-mail:
| | - DONATELLA PANATTO
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - FRANCESCO SAVERIO MENNINI
- Economic Evaluation and HTA - CEIS (EEHTA - CEIS), Facoltà di Economia, Università di Roma "Tor Vergata"
- Institute for Leadership and Management in Health, Kingston University, London, UK
| | - ANDREA MARCELLUSI
- Economic Evaluation and HTA - CEIS (EEHTA - CEIS), Facoltà di Economia, Università di Roma "Tor Vergata"
| | - CHIARA BINI
- Economic Evaluation and HTA - CEIS (EEHTA - CEIS), Facoltà di Economia, Università di Roma "Tor Vergata"
| | - DANIELA AMICIZIA
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - PIERO LUIGI LAI
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | | | - DAVIDE FRUMENTO
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - CHIARA AZZARI
- Immunologia, Clinica Pediatrica II, AOU Meyer, Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - SILVIA RICCI
- Immunologia, Clinica Pediatrica II, AOU Meyer, Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - BENEDETTA BONITO
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - GIULIA DI PISA
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | | | - LORENZO LODI
- Immunologia, Clinica Pediatrica II, AOU Meyer, Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - MATTIA GIOVANNINI
- Immunologia, Clinica Pediatrica II, AOU Meyer, Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - ANDREA MOSCADELLI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - SONIA PAOLI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | | | - LAURA PISANO
- Immunologia, Clinica Pediatrica II, AOU Meyer, Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - ANGELA BECHINI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - PAOLO BONANNI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
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Ladomenou F, Tzanakaki G, Kolyva S, Katsarakis I, Maraki S, Galanakis E. Conjugate vaccines dramatically reshaped the epidemiology of bacterial meningitis in a well-defined child population. Acta Paediatr 2020; 109:368-374. [PMID: 31365152 DOI: 10.1111/apa.14957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/02/2019] [Accepted: 07/30/2019] [Indexed: 12/26/2022]
Abstract
AIM We explored the impact of vaccination on bacterial meningitis in a well-defined population of children on the island of Crete, Greece, over a 27-y period. METHODS This was a retrospective observational study of all mandatory notifications of bacterial meningitis in patients aged 1 mo-14 y from 1991 to 2017. RESULTS There were 245 patients with proven (n = 227) or suspected (n = 18) bacterial meningitis, and eight deaths were recorded, giving a case fatality rate of 3.3%. The mean annual incidence rate (IR) per 100 000 children was 4.9 for Neisseria meningitidis, 2.2 for Streptococcus pneumoniae and 0.4 for Haemophilus influenzae type b (Hib). Cases of meningitis C dropped significantly after the conjugate meningitis C vaccine was licensed for routine vaccination in Greece in 2000 (IR of 1.5 vs 0.3, P < 0.028) while the Streptococcus pneumoniae cases showed a threefold decrease after the PCV13 vaccine was licensed in Greece in 2009 (IR 2.7 vs 1.0, P < 0.03). Vaccination had already eliminated Hib in Greece in the 1990s. CONCLUSION Bacterial meningitis cases decreased in children following the introduction of the meningitis C and PCV13 vaccines in Greece. Hib had already disappeared and significant reductions in meningitis C and Streptococcus pneumoniae were observed.
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Affiliation(s)
- Fani Ladomenou
- Department of Paediatrics, Venizeleion General Hospital of Heraklion, Heraklion, Greece
| | - Georgina Tzanakaki
- National Meningitis Reference Laboratory, National School of Public Health, Athens, Greece
| | - Soultana Kolyva
- Department of Paediatrics, Chania General Hospital, Chania, Greece
| | | | - Sofia Maraki
- Department of Microbiology, Heraklion University Hospital, Heraklion, Greece
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Vetter P, Schibler M, Herrmann JL, Boutolleau D. Diagnostic challenges of central nervous system infection: extensive multiplex panels versus stepwise guided approach. Clin Microbiol Infect 2019; 26:706-712. [PMID: 31899336 DOI: 10.1016/j.cmi.2019.12.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/20/2019] [Accepted: 12/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) testing is a key component for the diagnosis of central nervous system (CNS) infections. Current meningitis and encephalitis management guidelines agree on the need for CSF molecular testing in combination with other direct and indirect biological testing, both in CSF and blood. Multiplex molecular tests have been developed to reduce turnaround times and facilitate the diagnostic approach. OBJECTIVES We aim to discuss the role of multiplex molecular panels in the management of CNS infections. SOURCES The MEDLINE database and the grey literature have been searched for relevant articles. CONTENT New molecular multiplex panels are being developed to simultaneously detect a large array of neuropathogens in CSF. Although one of these assays has been US Food and Drug Administration-approved, extensive analytical and clinical validation is still missing, and suboptimal performance related issues have been raised. Its use has been associated with decreased costs, reduced length of hospital stay and reduced antiviral therapy administration in retrospective, industry-sponsored studies. The pros and cons of this multiplex syndromic approach are discussed in this narrative review. IMPLICATIONS Molecular multiplex CNS infection diagnosis panels have been developed and present several attractive features, including ease of use and low turnaround time. However, suboptimal analytical performances render these tests difficult to use without additional confirmatory tests. Such panels are not comprehensive nor adapted to all situations, depending on the epidemiological or clinical context. Overall, available data in the literature currently do not support the use of a multiplex PCR panel in clinical routine as a 'stand-alone' molecular assay. Except in restricted laboratory capacity settings where such easy-to-use multiplex panels offer the diagnostic means that would otherwise not be available, the stepwise testing approach remains a more rational option. Serological testing both in blood and CSF should not be neglected, but it represents essential complementary tools regarding some neuropathogens.
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Affiliation(s)
- P Vetter
- Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland; Infectious Diseases Division, Geneva University Hospitals, Geneva, Switzerland.
| | - M Schibler
- Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland; Infectious Diseases Division, Geneva University Hospitals, Geneva, Switzerland
| | - J L Herrmann
- 2I, UVSQ, INSERM, Université Paris Saclay, Versailles France; AP-HP, GHU Paris Saclay, Hôpital Raymond Poincaré, Garches, France
| | - D Boutolleau
- Sorbonne Université, INSERM, Institut Pierre Louis D'Epidémiologie et de Santé Publique (iPLESP), Paris, France; AP-HP, GHU AP-HP. Sorbonne Université, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Virology Department, National Reference Center for Herpesviruses (associate Laboratory), Paris, France
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Guiducci S, Moriondo M, Nieddu F, Ricci S, De Vitis E, Casini A, Poggi GM, Indolfi G, Resti M, Azzari C. Culture and Real-time Polymerase Chain reaction sensitivity in the diagnosis of invasive meningococcal disease: Does culture miss less severe cases? PLoS One 2019; 14:e0212922. [PMID: 30865671 PMCID: PMC6415896 DOI: 10.1371/journal.pone.0212922] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 02/12/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Invasive meningococcal disease (IMD) is a highly lethal disease. Diagnosis is commonly performed by culture or Realtime-PCR (qPCR). AIMS Our aim was to evaluate, retrospectively, whether culture positivity correlates with higher bacterial load and fatal outcome. Our secondary aim was to compare culture and qPCR sensitivity. METHODS The National Register for Molecular Surveillance was used as data source. Cycle threshold (CT), known to be inversely correlated with bacterial load, was used to compare bacterial load in different samples. RESULTS Three-hundred-thirteen patients were found positive for Neisseria meningitidis by qPCR, or culture, or both; 41 died (case fatality rate 13.1%); 128/143 (89.5%) blood samples and 138/144 (95.8%) CSF were positive by qPCR, 37/143 (25.9%) blood samples and 45/144 (31.2%) CSF were also positive in culture. qPCR was 3.5 times (blood) or 3.1 times (CSF) more sensitive than culture in achieving a laboratory diagnosis of IMD (OR 24.4; 95% CI 12.2-49.8; p < .10-4; Cohen's κ 0.08 for blood and OR 49.0; 95% CI 19.1-133.4; p<10-4; Cohen's κ 0.02; for CSF). Positivity of culture did not correlate with higher bacterial loads in blood (mean CT 27.7±5.71, and CT 28.1±6.03, p = 0.739 respectively in culture positive or negative samples) or in CSF (mean CT 23.1±4.9 and 24.7±5.4 respectively in positive or negative CSF samples, p = 0.11).CT values in blood from patients who died were significantly lower than in patients who survived (respectively mean 18.0, range 14-23 and mean 29.6, range 16-39; p<10-17). No deaths occurred in patients with CT in blood over 23. Positive blood cultures were found in 10/25 (40%) patients who died and in 32/163 (19.6%) patients who survived, p = 0.036, OR 2.73; 95% CL 1.025-7.215), however 60% of deaths would have remained undiagnosed with the use of culture only. CONCLUSIONS In conclusion our study demonstrated that qPCR is significantly (at least 3 times) more sensitive than culture in the laboratory confirmation of IMD. The study also demonstrated that culture negativity is not associated with lower bacterial loads and with less severe cases. On the other side, in patients with sepsis, qPCR can predict fatal outcome since higher bacterial load, evaluated by qPCR, appears strictly associated with most severe cases and fatal outcome. The study also showed that molecular techniques such as qPCR can provide a valuable addition to the proportion of diagnosed and serotyped cases of IMD.
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Affiliation(s)
- Sara Guiducci
- Department of Health Sciences, Section of Pediatrics, University of Florence, Florence, Italy
- Pediatric Clinic 2, Pediatric Immunology, Meyer Children’s Hospital, Florence, Italy
| | - Maria Moriondo
- Department of Health Sciences, Section of Pediatrics, University of Florence, Florence, Italy
| | - Francesco Nieddu
- Department of Health Sciences, Section of Pediatrics, University of Florence, Florence, Italy
- Pediatric Clinic 2, Pediatric Immunology, Meyer Children’s Hospital, Florence, Italy
- * E-mail:
| | - Silvia Ricci
- Department of Health Sciences, Section of Pediatrics, University of Florence, Florence, Italy
- Pediatric Clinic 2, Pediatric Immunology, Meyer Children’s Hospital, Florence, Italy
| | - Elisa De Vitis
- Department of Health Sciences, Section of Pediatrics, University of Florence, Florence, Italy
- Pediatric Clinic 2, Pediatric Immunology, Meyer Children’s Hospital, Florence, Italy
| | - Arianna Casini
- Department of Health Sciences, Section of Pediatrics, University of Florence, Florence, Italy
| | - Giovanni Maria Poggi
- Department of Health Sciences, Section of Pediatrics, University of Florence, Florence, Italy
- Department of Interdisciplinary Pediatrics, Section of Medical Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Giuseppe Indolfi
- Department of Interdisciplinary Pediatrics, Section of Medical Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Massimo Resti
- Department of Interdisciplinary Pediatrics, Section of Medical Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Chiara Azzari
- Department of Health Sciences, Section of Pediatrics, University of Florence, Florence, Italy
- Pediatric Clinic 2, Pediatric Immunology, Meyer Children’s Hospital, Florence, Italy
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Ricci S, Montemaggi A, Nieddu F, Serranti D, Indolfi G, Moriondo M, Azzari C. Is primary meningococcal arthritis in children more frequent than we expect? Two pediatric case reports revealed by molecular test. BMC Infect Dis 2018; 18:703. [PMID: 30591016 PMCID: PMC6307139 DOI: 10.1186/s12879-018-3602-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 12/10/2018] [Indexed: 11/19/2022] Open
Abstract
Background Primary meningococcal arthritis is a rare infectious disease that occurs in less than 3% of meningococcal infections and is characterized by arthritis without meningitis, fever, rash, or hemodynamic instability Barahona [Case Rep Orthop 4696014:2017 ]. There are no validated clinical criteria that can be used for the diagnosis. We present two pediatric cases of atypical presentation of meningococcal disease revealed by molecular tests. Case presentation The clinical presentation of the two children (6- and 9-years-old) was characterized by signs of arthritis. By Real Time Polymerase Chain Reaction (RT-PCR), we identified N. meningitidis serogroup Y in the joint fluid in both cases. After specific antimicrobial treatment, the clinical conditions of the two patients quickly improved during hospitalization. Conclusions. We believe that the incidence of meningococcal arthritis could be underestimated in those settings where the use of RT-PCR is limited. Clearer data on the incidence of meningococcal disease would help to design specific treatments and the best possible national vaccine strategies [Fiji Sci Rep 23:39784, 2016, J Infect 67:385-90, 2013].
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Affiliation(s)
- S Ricci
- Immunology Division, Section of Pediatrics, Department of Health Sciences, University of Florence and Meyer Children's University Hospital, Florence, Italy.
| | - A Montemaggi
- Section of Paediatrics, Meyer Children's University Hospital, Florence, Italy
| | - F Nieddu
- Section of Paediatrics, Meyer Children's University Hospital, Florence, Italy
| | - D Serranti
- Section of Paediatrics, Meyer Children's University Hospital, Florence, Italy
| | - G Indolfi
- Section of Pediatrics, Department of Neurofarba, University of Florence and Meyer Children's University Hospital, Florence, Italy
| | - M Moriondo
- Immunology Division, Section of Pediatrics, Department of Health Sciences, University of Florence and Meyer Children's University Hospital, Florence, Italy
| | - C Azzari
- Immunology Division, Section of Pediatrics, Department of Health Sciences, University of Florence and Meyer Children's University Hospital, Florence, Italy
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Ma YF, Wen L, Zhu Y. Prospective study evaluating post-operative central nervous system infections following cranial surgery. Br J Neurosurg 2018; 33:80-83. [PMID: 30282490 DOI: 10.1080/02688697.2018.1519112] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Yi-Fang Ma
- Department of Operating Theatre, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou City, China
| | - Liang Wen
- Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou City, China
| | - Yu Zhu
- Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou City, China
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Jiang H, Su M, Kui L, Huang H, Qiu L, Li L, Ma J, Du T, Fan M, Sun Q, Liu X. Prevalence and antibiotic resistance profiles of cerebrospinal fluid pathogens in children with acute bacterial meningitis in Yunnan province, China, 2012-2015. PLoS One 2017; 12:e0180161. [PMID: 28662145 PMCID: PMC5491142 DOI: 10.1371/journal.pone.0180161] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 06/10/2017] [Indexed: 11/18/2022] Open
Abstract
Acute bacterial meningitis is still considered one of the most dangerous infectious diseases in children. To investigate the prevalence and antibiotic resistance profiles of cerebrospinal fluid (CSF) pathogens in children with acute bacterial meningitis in Southwest China, CSF samples from 179 meningitis patients (3 days to 12 years old) with positive culture results were collected from 2012 to 2015. Isolated pathogens were identified using the Vitek-32 system. Gram stain results were used to guide subcultures and susceptibility testing. The antimicrobial susceptibility of isolates was determined using the disc diffusion method. Of the isolates, 50.8% were Gram-positive bacteria, and 49.2% were Gram-negative bacteria. The most prevalent pathogens were E. coli (28.5%), Streptococcus pneumoniae (17.8%), Staphylococcus epidermidis (10.0%), Haemophilus influenzae type b (9.5%), and group B streptococcus (7.2%). In young infants aged ≤3 months, E. coli was the organism most frequently isolated from CSF (39/76; 51.3%), followed by group B streptococcus (13/76; 17.1%) and Streptococcus pneumoniae (8/76; 10.5%). However, in young infants aged >3 months, the most frequently isolated organism was Streptococcus pneumoniae (24/103; 23.3%), followed by Staphylococcus epidermidis (18/103; 17.5%) and Haemophilus influenzae type b (16/103; 15.5%). Antimicrobial susceptibility tests indicated that for E. coli isolates, the susceptibility rates to aminoglycosides ranged from 56.8% to 100.0%, among them, amikacin was identified as the most effective against E. coli. As for cephalosporins, the susceptibility rates ranged from 29.4% to 78.4%, and cefoxitin was identified as the most effective cephalosporin. In addition, the susceptibility rates of piperacillin/tazobactam and imipenem against E. coli were 86.3% and 100%. Meanwhile, the susceptibility rates of Streptococcus pneumoniae isolates to penicillin G, erythromycin, chloramphenicol, ceftriaxone and tetracycline were 68.8%, 0.0%, 87.5%, 81.3% and 0.0%, respectively. Gentamycin, ofloxacin, linezolid and vancomycin were identified as the most effective antibiotics for Streptococcus pneumoniae, each with susceptibility rates of 100%. It was notable that other emerging pathogens, such as Listeria monocytogenes and group D streptococcus, cannot be underestimated in meningitis.
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Affiliation(s)
- Hongchao Jiang
- The Affiliated Children's Hospital of Kunming Medical University, Kunming, P.R. China.,Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, P.R. China
| | - Min Su
- The Affiliated Children's Hospital of Kunming Medical University, Kunming, P.R. China
| | - Liyue Kui
- The Affiliated Children's Hospital of Kunming Medical University, Kunming, P.R. China
| | - Hailin Huang
- The Affiliated Children's Hospital of Kunming Medical University, Kunming, P.R. China
| | - Lijuan Qiu
- The Affiliated Children's Hospital of Kunming Medical University, Kunming, P.R. China.,Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, P.R. China
| | - Li Li
- The Affiliated Children's Hospital of Kunming Medical University, Kunming, P.R. China
| | - Jing Ma
- The Affiliated Children's Hospital of Kunming Medical University, Kunming, P.R. China
| | - Tingyi Du
- The Affiliated Children's Hospital of Kunming Medical University, Kunming, P.R. China
| | - Mao Fan
- The Affiliated Children's Hospital of Kunming Medical University, Kunming, P.R. China
| | - Qiangming Sun
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, P.R. China.,Yunnan Key Laboratory of Vaccine Research & Development on Severe Infectious Diseases, Kunming, PR China
| | - Xiaomei Liu
- The Affiliated Children's Hospital of Kunming Medical University, Kunming, P.R. China
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Neutrophil-to-lymphocyte ratio in the differential diagnosis of acute bacterial meningitis. Eur J Clin Microbiol Infect Dis 2016; 35:397-403. [PMID: 26792137 DOI: 10.1007/s10096-015-2552-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 12/07/2015] [Indexed: 01/04/2023]
Abstract
The differential diagnosis of acute community-acquired meningitis is of paramount importance in both therapeutic and healthcare-related economic terms. Despite the routinely used markers, novel, easily calculated, and rapidly available biomarkers are needed particularly in resource-poor settings. A promising, exponentially studied inflammatory marker is the neutrophil-to-lymphocyte ratio (NLR), albeit not assessed in meningitis. The aim of this study was to investigate the utility of the NLR in the differential diagnosis of acute meningitis. Data on cerebrospinal fluid (CSF) and blood leukocyte parameters from more than 4,000 patients diagnosed with either bacterial or viral meningitis in Greece during the period 2006-2013 were retrospectively examined. The diagnostic accuracy of the NLR and neutrophil counts in CSF and blood were evaluated by receiver operating characteristic curves. The discrimination ability of both the NLR and neutrophil counts was significantly higher in CSF than in blood. The optimal cutoff values of the NLR and neutrophil counts were 2 in CSF vs 8 in blood, and 287 cells in CSF vs 12,100 cells in blood, respectively. For these values, sensitivity, negative predictive value, and odds ratio were statistically significantly higher in CSF than blood for both markers. Logistic regression analysis showed that the CSF NLR carries independent and additive information to neutrophil counts in the differential diagnosis of acute meningitis. This study is the first one to assess NLR in acute meningitis, providing promising results for its differential diagnosis.
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12
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Acute meningitis in rats is associated with decreased levels of miR132 and miR146a. Cent Eur J Immunol 2014; 39:316-22. [PMID: 26155141 PMCID: PMC4439992 DOI: 10.5114/ceji.2014.45941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 06/06/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction The pathogenesis of bacterial meningitis due to Streptococcus pneumoniae is still unclear. Despite early treatment with antibiotics, its morbidity and mortality is still high. Material and methods Streptococcus pneumoniae induced rat meningitis models were taken and divided into 2 groups; control (C) and meningitis (M). Western blot was used to detect toll like receptor 4 (TLR4), tumor necrosis factor α (TNF-α), interleukin 1B (IL1B), nuclear factor κB (NFκB) and real time polymerase chain reaction were used to detect the expression of miR146a, miR132, respectively. Results We found that the expressions of TLR4, TNF-α, IL1B, NFκB were all up-regulated in the acute stage of bacterial meningitis when compared to the control group. While for the post transcription factors, miR146a and miR132, the opposite was observed. They were down-regulated in the meningitis group. Conclusions miR146a and miR132 may take part in the pathogenesis of SP bacterial meningitis as well as the TLR4- NFκB- TNF-α/IL1B signal transduction pathway.
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Abstract
Polymerase chain reaction-based surveillance for bacterial meningitis including 841 children revealed 246 with bacterial DNA in cerebrospinal fluid samples of which 53% were Streptococcus pneumoniae, 19% Neisseria meningitidis, and 16% Haemophilus influenzae type b. The most common S. pneumoniae serotypes/serogroups were 1, 19F, 6A/6B, 23F, 5, 14, 18 and 19A. Among 47 meningococci, 86% were serogroup B, 6% serogroup C, 3% serogroup A, 3% serogroup X and 3% serogroup W.
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14
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Skoczyńska A, Waśko I, Kuch A, Kadłubowski M, Gołębiewska A, Foryś M, Markowska M, Ronkiewicz P, Wasiak K, Kozińska A, Matynia B, Hryniewicz W. A decade of invasive meningococcal disease surveillance in Poland. PLoS One 2013; 8:e71943. [PMID: 23977184 PMCID: PMC3748050 DOI: 10.1371/journal.pone.0071943] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/04/2013] [Indexed: 11/21/2022] Open
Abstract
Background Neisseria meningitidis is a leading etiologic agent of severe invasive disease. The objective of the study was to characterise invasive meningococcal disease (IMD) epidemiology in Poland during the last decade, based on laboratory confirmed cases. Methods The study encompassed all invasive meningococci collected between 2002 and 2011 in the National Reference Centre for Bacterial Meningitis. The isolates were re-identified and characterised by susceptibility testing, MLST analysis, porA and fetA sequencing. A PCR technique was used for meningococcal identification directly from clinical materials. Results In the period studied, 1936 cases of IMD were confirmed, including 75.6% identified by culture. Seven IMD outbreaks, affecting mostly adolescents, were reported; all were caused by serogroup C meningococci of ST-11. The highest incidence was observed among children under one year of age (15.71/100,000 in 2011). The general case fatality rate in the years 2010–2011 was 10.0%. Meningococci of serogroup B, C, Y and W-135 were responsible for 48.8%, 36.6%, 1.2% and 1.2% of cases, respectively. All isolates were susceptible to third generation cephalosporins, chloramphenicol, ciprofloxacin, and 84.2% were susceptible to penicillin. MLST analysis (2009–2011) revealed that among serogroup B isolates the most represented were clonal complexes (CC) ST-32CC, ST-18CC, ST-41/44CC, ST-213CC and ST-269CC, and among serogroup C: ST-103CC, ST-41/44CC and ST-11CC. Conclusions The detection of IMD in Poland has changed over time, but observed increase in the incidence of the disease was mostly attributed to changes in the surveillance system including an expanded case definition and inclusion of data from non-culture diagnostics.
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Affiliation(s)
- Anna Skoczyńska
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
- * E-mail:
| | - Izabela Waśko
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Alicja Kuch
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Marcin Kadłubowski
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Agnieszka Gołębiewska
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Małgorzata Foryś
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Marlena Markowska
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Patrycja Ronkiewicz
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Katarzyna Wasiak
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Aleksandra Kozińska
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Bożena Matynia
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Waleria Hryniewicz
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
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