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Ivaska L, Herberg J, Sadarangani M. Distinguishing community-acquired bacterial and viral meningitis: Microbes and biomarkers. J Infect 2024; 88:106111. [PMID: 38307149 DOI: 10.1016/j.jinf.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Abstract
Diagnostic tools to differentiate between community-acquired bacterial and viral meningitis are essential to target the potentially lifesaving antibiotic treatment to those at greatest risk and concurrently spare patients with viral meningitis from the disadvantages of antibiotics. In addition, excluding bacterial meningitis and thus decreasing antibiotic consumption would be important to help reduce antimicrobial resistance and healthcare expenses. The available diagnostic laboratory tests for differentiating bacterial and viral meningitis can be divided microbiological pathogen-focussed methods and biomarkers of the host response. Bacterial culture-independent microbiological methods, such as highly multiplexed nucleic acid amplification tests, are rapidly making their way into the clinical practice. At the same time, more conventional host protein biomarkers, such as procalcitonin and C-reactive protein, are supplemented by newer proteomic and transcriptomic signatures. This review aims to summarise the current state and the recent advances in diagnostic methods to differentiate bacterial from viral meningitis.
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Affiliation(s)
- Lauri Ivaska
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Savitehtaankatu 5, 20521 Turku, Finland; InFLAMES Research Flagship Center, University of Turku, Kiinanmyllynkatu 10, 20520 Turku, Finland.
| | - Jethro Herberg
- Section of Paediatric Infectious Disease, Faculty of Medicine, Imperial College London, Norfolk Place, London, United Kingdom.
| | - Manish Sadarangani
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.
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2
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Zhang C, Sun L, Wang D, Li Y, Zhang L, Wang L, Peng J. Advances in antimicrobial resistance testing. Adv Clin Chem 2022; 111:1-68. [DOI: 10.1016/bs.acc.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Ren D, Wu D, Liu F, Jiao S, Wu Y. Diagnostic value of heparin-binding protein in the cerebrospinal fluid for purulent meningitis in children. ACTA ACUST UNITED AC 2021; 54:e11295. [PMID: 34495248 PMCID: PMC8427748 DOI: 10.1590/1414-431x2021e11295] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/07/2021] [Indexed: 11/21/2022]
Abstract
This study aimed to investigate the diagnostic value of heparin-binding protein (HBP) in the cerebrospinal fluid of children with purulent meningitis (PM). This study included 118 children with PM diagnosed at our hospital from January 2018 to January 2020, 110 children with viral meningitis (VM) and 80 children with suspected meningitis who were ruled out by cerebrospinal fluid (CSF) analysis during the same period. HBP and white blood cell (WBC) count in the CSF, and inflammatory factors, including C-reactive protein (CRP), tumor necrosis factor (TNF)-α, and procalcitonin (PCT), were measured. Receiver-operator characteristic curves were used to analyze the predictive value of HBP, CRP, PCT, and TNF-α levels in the diagnosis of PM by CSF analysis. HBP levels in the CSF of children with PM were higher, while the CRP and serum PCT and TNF-α levels were elevated in all groups (P<0.05). In addition, HBP levels in the CSF were more accurate for the diagnosis of PM than traditional diagnostic indexes. HBP levels in the CSF can be used as an important reference for early diagnosis of PM.
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Affiliation(s)
- Dan Ren
- Department of Pediatrics, Mianyang Central Hospital, Mianyang, Sichuan, China
| | - Di Wu
- Department of Gynecology and Pediatrics, Hospital of PLA Unit 63820, Mianyang, Sichuan, China
| | - Fu Liu
- Department of Pediatrics, Mianyang Central Hospital, Mianyang, Sichuan, China
| | - Shuli Jiao
- Department of Pediatrics, Mianyang Central Hospital, Mianyang, Sichuan, China
| | - Yi Wu
- Department of Pediatrics, Mianyang Central Hospital, Mianyang, Sichuan, China
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Minias A, Żukowska L, Lach J, Jagielski T, Strapagiel D, Kim SY, Koh WJ, Adam H, Bittner R, Truden S, Žolnir-Dovč M, Dziadek J. Subspecies-specific sequence detection for differentiation of Mycobacterium abscessus complex. Sci Rep 2020; 10:16415. [PMID: 33009494 PMCID: PMC7532137 DOI: 10.1038/s41598-020-73607-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/11/2020] [Indexed: 12/11/2022] Open
Abstract
Mycobacterium abscessus complex (MABC) is a taxonomic group of rapidly growing, nontuberculous mycobacteria that are found as etiologic agents of various types of infections. They are considered as emerging human pathogens. MABC consists of 3 subspecies—M. abscessus subsp. bolletti, M. abscessus subsp. massiliense and M. abscessus subsp. abscessus. Here we present a novel method for subspecies differentiation of M. abscessus named Subspecies-Specific Sequence Detection (SSSD). This method is based on the presence of signature sequences present within the genomes of each subspecies of MABC. We tested this method against a virtual database of 1505 genome sequences of MABC. Further, we detected signature sequences of MABC in 45 microbiological samples through DNA hybridization. SSSD showed high levels of sensitivity and specificity for differentiation of subspecies of MABC, comparable to those obtained by rpoB sequence typing.
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Affiliation(s)
- Alina Minias
- Institute of Medical Biology, Polish Academy of Sciences, ul. Lodowa 106, 93-232, Lodz, Poland.
| | - Lidia Żukowska
- BioMedChem Doctoral School of the University of Lodz, The Institutes of the Polish Academy of Sciences, Lodz, Poland
| | - Jakub Lach
- Biobank Lab, Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
| | - Tomasz Jagielski
- Department of Medical Microbiology, Institute of Microbiology, Faculty of Biology, University of Warsaw, Warsaw, Poland
| | - Dominik Strapagiel
- Biobank Lab, Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
| | - Su-Young Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Heather Adam
- Diagnostic Services, Shared Health, Winnipeg, MB, Canada
| | - Ruth Bittner
- Diagnostic Services, Shared Health, Winnipeg, MB, Canada
| | - Sara Truden
- National Reference Laboratory for Mycobacteria, University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Manca Žolnir-Dovč
- National Reference Laboratory for Mycobacteria, University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Jarosław Dziadek
- Institute of Medical Biology, Polish Academy of Sciences, ul. Lodowa 106, 93-232, Lodz, Poland
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Li H, Xiao R, Javed R, Li K, Ye W, Zhou W, Liang H. Evaluation of cerebrospinal fluid and blood parameters finding in early diagnosis and drug therapy of suspected bacterial meningitis in neonates. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2020; 25:77. [PMID: 33088314 PMCID: PMC7554534 DOI: 10.4103/jrms.jrms_470_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 11/26/2019] [Accepted: 04/18/2020] [Indexed: 11/17/2022]
Abstract
Background: Whether early lumbar puncture (LP) and blood indicators are suitable as diagnostic criteria and helpful to treatment strategies for newborns remains to be solved. The study was to evaluate the value of cerebrospinal fluid (CSF) at the first LP and blood indicators at the similar time in the early diagnosis and the drug therapy of neonatal bacterial meningitis. Materials and Methods: We conducted a retrospective observational study of 997 infants with suspected bacterial meningitis between June 2012 and June 2018. CSF and blood parameters were evaluated by three stepwise logistic models to assess their ability: to distinguish bacterial meningitis from nonbacterial meningitis, to distinguish positive CSF culture from negative, and to distinguish Gram-positive bacteria from negative. Results: Of the 997 neonates, 236 (23.67%) were later diagnosed as bacterial meningitis. Of the neonates with meningitis, 54 (22.88%) had positive CSF culture results. And of neonates with positive CSF culture, 27 (50%) had Gram-positive results. One or more CSF indicators were added to the three models. Only blood hypersensitive C-reactive protein and blood lactate dehydrogenase were added to the first model, while no blood parameters was added to the other two models. The areas under the effect-time curves of the three models were 0.91 (95% confidence interval [CI]: 0.89–0.92, P < 0.001), 0.69 (95% CI: 0.63–0.75, P < 0.001), and 0.86 (95% CI: 0.74–0.94, P < 0.001), respectively. Conclusion: LP was irreplaceable predictor of bacterial meningitis, and comprehensive analysis of CSF indicators can predict the offending organism, which enables refinement of therapy.
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Affiliation(s)
- Huixian Li
- Guangzhou Women and Children's Medical Center, Institute of Pediatrics, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Rui Xiao
- Department of Respiration, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Ruheena Javed
- Guangzhou Women and Children's Medical Center, Institute of Pediatrics, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Kuanrong Li
- Guangzhou Women and Children's Medical Center, Institute of Pediatrics, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Weitao Ye
- Public Health School, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wei Zhou
- Guangzhou Women and Children's Medical Center, Neonatal Intensive Care Unit, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Huiying Liang
- Guangzhou Women and Children's Medical Center, Institute of Pediatrics, Guangzhou Medical University, Guangzhou, Guangdong, China
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Abstract
PURPOSE OF REVIEW Central nervous system (CNS) infections present an ongoing diagnostic challenge for clinicians, with an aetiological agent remaining unidentified in the majority of cases even in high-income settings. This review summarizes developments in a range of diagnostic methods published in the past 18 months. RECENT FINDINGS Several commercial assays exist for the detection of viral, bacterial and fungal pathogens using single multiplex PCR. Multicentre validation of the Biofire FilmArray panel illustrated high sensitivity for bacterial and fungal pathogens, but poor results for Cryptococcus species detection. The development of microarray cards for bacterial CNS pathogens shows promise but requires further validation. Few developments have been made in proteomics and transcriptomics, contrasted with significant increase in the use of metagenomic (or unbiased) sequencing. Novel viruses causing CNS infection have been described using this technique but contamination, cost, expertise and turnaround time requirements remain restrictive. Finally, the development of Gene Xpert and Ultra has revolutionized tuberculosis meningitis diagnostics with newly released recommendations for their use from the WHO. SUMMARY Progress has been made in the clinical validation and international recommendation of PCR-based tests for CNS infections. Sequencing techniques present the most dynamic field, although significant ongoing challenges persist.
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Abstract
PURPOSE OF REVIEW Management of patients with meningitis and encephalitis oftentimes requires ICU level of care. This article is an update on management for meningitis and encephalitis with focus on clinical care in the ICU. Information provided is based on a review of recent studies with focus on studies since 2017. RECENT FINDINGS Advances in diagnostic and treatment approach for different pathogens are presented. Nosocomial meningitis now constitutes a major part of brain infections seen in ICUs in the developed world. Advances in ICU care of central nervous system (CNS) infections include application of newer diagnostic methods, improved understanding and delivery of antibiotics to the CNS, infection prevention for nosocomial infections, and application of neuromonitoring where indicated. SUMMARY Advances in diagnostics and therapeutic approach to CNS infections are continually made. For intensivists, focus on neuromonitoring and brain resuscitation in critically ill patients with CNS infections may present a path to enhance preservation of brain function and improve outcomes. VIDEO ABSTRACT: http://links.lww.com/COCC/A22.
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Li C, Fu G, Shi Y, Zhang AM, Xia X, Fang Y, Mao X, Jiang J, Song Y, Yang G. Rapid, specific, and sensitive detection of the ureR_1 gene in Klebsiella pneumoniae by loop-mediated isothermal amplification method. ACTA ACUST UNITED AC 2019; 52:e8186. [PMID: 30916220 PMCID: PMC6437934 DOI: 10.1590/1414-431x20198186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/21/2019] [Indexed: 12/15/2022]
Abstract
Klebsiella pneumoniae is one of the main pathogenic bacteria that causes nosocomial infections, such as pneumonia, urinary tract infection, and sepsis. Therefore, the rapid and accurate detection of K. pneumoniae is important for the timely treatment of infectious patients. This study aimed to establish a loop-mediated isothermal amplification (LAMP) method for the rapid and sensitive detection of K. pneumoniae-specific gene ureR_1 (Gene ID: 11847803). The ureR_1 gene was obtained through local and online BLAST, and the specific primers were designed for its detection. Positive reactions were observed on all 140 K. pneumoniae clinical isolates while all the 82 non-K. pneumoniae clinical isolates were negative. Plasmids with the specific gene and the mouse blood with K. pneumoniae were used for sensitivity analysis. The detection limit of the LAMP was 1 bacterium/reaction. The results showed that the LAMP targeted to ureR_1 is a fast, specific, sensitive, inexpensive, and suitable method for the detection of K. pneumoniae.
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Affiliation(s)
- Chao Li
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China.,Molecular Medicine Center of Yunnan Province, Kunming, Yunnan, China
| | - Gongyu Fu
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China.,Molecular Medicine Center of Yunnan Province, Kunming, Yunnan, China
| | - Yaoqiang Shi
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China.,Molecular Medicine Center of Yunnan Province, Kunming, Yunnan, China
| | - A-Mei Zhang
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China.,Molecular Medicine Center of Yunnan Province, Kunming, Yunnan, China
| | - Xueshan Xia
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China.,Molecular Medicine Center of Yunnan Province, Kunming, Yunnan, China
| | - Yue Fang
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China.,Molecular Medicine Center of Yunnan Province, Kunming, Yunnan, China
| | - Xiaoqin Mao
- Molecular Medicine Center of Yunnan Province, Kunming, Yunnan, China.,Department of Clinical Laboratory, First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Jie Jiang
- Molecular Medicine Center of Yunnan Province, Kunming, Yunnan, China.,Department of Clinical Laboratory, First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Yuzhu Song
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China.,Molecular Medicine Center of Yunnan Province, Kunming, Yunnan, China
| | - Guangying Yang
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China.,Molecular Medicine Center of Yunnan Province, Kunming, Yunnan, China.,Yunnan SciSpark Biotechnology Co. Ltd., Kunming, Yunnan, China
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