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Anne RP, Dutta S, Balasubramanian H, Aggarwal AN, Chadha N, Kumar P. Meta-analysis of Cerebrospinal Fluid Cell Count and Biochemistry to Diagnose Meningitis in Infants Aged < 90 Days. Am J Perinatol 2024; 41:e1962-e1975. [PMID: 37196663 DOI: 10.1055/a-2095-6729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Cerebrospinal fluid (CSF) white blood cell (WBC) count, protein, and glucose (cytochemistry) are performed to aid in the diagnosis of meningitis in young infants. However, studies have reported varying diagnostic accuracies. We assessed the diagnostic accuracy of CSF cytochemistry in infants below 90 days and determined the certainty of evidence. STUDY DESIGN We searched PubMed, Embase, Cochrane Library, Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases in August 2021. We included studies that evaluated the diagnostic accuracy of CSF cytochemistry compared with CSF culture, Gram stain, or polymerase chain reaction in neonates and young infants <90 days with suspected meningitis. We pooled data using the hierarchical summary receiver operator characteristic (ROC) model. RESULTS Of the 10,720 unique records, 16 studies were eligible for meta-analysis, with a cumulative sample size of 31,695 (15 studies) for WBC, 12,936 (11 studies) for protein, and 1,120 (4 studies) for glucose. The median (Q1, Q3) specificities of WBC, protein, and glucose were 87 (82, 91), 89 (81, 94), and 91% (76, 99), respectively. The pooled sensitivities (95% confidence interval [CI]) at median specificity of WBC count, protein, and glucose were 90 (88, 92), 92 (89, 94), and 71% (54, 85), respectively. The area (95% CI) under ROC curves were 0.89 (0.87, 0.90), 0.87 (0.85, 0.88), and 0.81 (0.74, 0.88) for WBC, protein, and glucose, respectively. There was an unclear/high risk of bias and applicability concern in most studies. Overall certainty of the evidence was moderate. A bivariate model-based analysis to estimate the diagnostic accuracy at specific thresholds could not be conducted due to a paucity of data. CONCLUSION CSF WBC and protein have good diagnostic accuracy for the diagnosis of meningitis in infants below 90 days of age. CSF glucose has good specificity but poor sensitivity. However, we could not identify enough studies to define an optimal threshold for the positivity of these tests. KEY POINTS · Median specificity of CSF leucocyte count, protein and glucose are similar in young infants.. · At median specificity, CSF leukocyte count and protein are more sensitive than glucose.. · Owing to inadequate data, bivariate modelling to suggest optimal diagnostic thresholds is not possible..
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Affiliation(s)
- Rajendra P Anne
- Department of Pediatrics, Division of Neonatology, Kasturba Medical College, Manipal, Karnataka, India
| | - Sourabh Dutta
- Department of Pediatrics, Neonatology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Ashutosh N Aggarwal
- Department of Pulmonology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelima Chadha
- Dr. Tulsi Das Library, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar
- Department of Pediatrics, Neonatology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Matys J, Kensy J, Gedrange T, Zawiślak I, Grzech-Leśniak K, Dobrzyński M. A Molecular Approach for Detecting Bacteria and Fungi in Healthcare Environment Aerosols: A Systematic Review. Int J Mol Sci 2024; 25:4154. [PMID: 38673740 PMCID: PMC11050369 DOI: 10.3390/ijms25084154] [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: 02/25/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Molecular methods have become integral to microbiological research for microbial identification. This literature review focuses on the application of molecular methods in examining airborne bacteria and fungi in healthcare facilities. In January 2024, a comprehensive electronic search was carried out in esteemed databases including PubMed, Web of Science, and Scopus, employing carefully selected keywords such as ((bacteria) OR (virus) OR (fungi)) AND (aerosol) AND ((hospital) OR (healthcare) OR (dental office)) AND ((molecular) OR (PCR) OR (NGS) OR (RNA) OR (DNA) OR (metagenomic) OR (microarray)), following the PRISMA protocol. The review specifically targets healthcare environments with elevated concentrations of pathogenic bacteria. A total of 487 articles were initially identified, but only 13 met the inclusion criteria and were included in the review. The study disclosed that the prevalent molecular methodology for appraising aerosol quality encompassed the utilization of the PCR method, incorporating either 16S rRNA (bacteria) or 18S rRNA (fungi) amplification techniques. Notably, five diverse molecular techniques, specifically PFGE, DGGE, SBT, LAMP, and DNA hybridization methods, were implemented in five distinct studies. These molecular tests exhibited superior capabilities compared to traditional bacterial and fungal cultures, providing precise strain identification. Additionally, the molecular methods allowed the detection of gene sequences associated with antibiotic resistance. In conclusion, molecular testing offers significant advantages over classical microbiological culture, providing more comprehensive information.
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Affiliation(s)
- Jacek Matys
- Oral Surgery Department, Medical University of Wroclaw, 50-425 Wroclaw, Poland; (T.G.); (K.G.-L.)
| | - Julia Kensy
- Faculty of Dentistry, Medical University of Wroclaw, 50-425 Wroclaw, Poland;
| | - Tomasz Gedrange
- Oral Surgery Department, Medical University of Wroclaw, 50-425 Wroclaw, Poland; (T.G.); (K.G.-L.)
| | - Ireneusz Zawiślak
- Faculty of Biotechnology and Food Sciences, Wrocław University of Environmental and Life Sciences, 37 Chełmońskiego Str., 51-630 Wrocław, Poland;
| | - Kinga Grzech-Leśniak
- Oral Surgery Department, Medical University of Wroclaw, 50-425 Wroclaw, Poland; (T.G.); (K.G.-L.)
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Maciej Dobrzyński
- Department of Pediatric Dentistry and Preclinical Dentistry, Wroclaw Medical University, Krakowska 26, 50-425 Wrocław, Poland;
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van der Hoeven A, van der Beek MT, Bekker V, Meijers E, Ivens MJR, Wessels E, Kroes ACM, Boers SA. Improved Diagnostics in Bacterial Neonatal Meningitis Using a Next-Generation Sequencing Platform. Infect Dis Ther 2023:10.1007/s40121-023-00844-8. [PMID: 37436676 PMCID: PMC10390448 DOI: 10.1007/s40121-023-00844-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/27/2023] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION Bacterial meningitis in infants is an infrequent but life-threatening condition. Empiric therapy should begin as soon as meningitis is thought likely. Consequently, the causative microorganisms may not always be detected using culturing techniques, as cerebrospinal fluid (CSF) cultures are influenced by antibiotics. Nucleic acid amplification tests, such as polymerase chain reaction (PCR) (multiplex panels), may overcome this limitation but require a priori knowledge of the likely pathogen present within the sample. With this in mind, we investigated to what extent a culture-free, broad-range 16S rRNA gene next-generation sequencing (NGS) platform (MYcrobiota) could add to the microbiological diagnosis of meningitis. METHODS Retrospective cohort study at level III neonatal intensive care unit. Included were all infants with suspected meningitis admitted between 10 November 2017 and 31 December 2020. A comparison was made of the bacterial pathogen detection rate between MYcrobiota and conventional bacterial culture. RESULTS In a 3-year period, 37 CSF samples (diagnostic and follow-up) from 35 infants with proven or possible meningitis were available for MYcrobiota testing. MYcrobiota detected the presence of bacterial pathogens in 11 samples (30%), in contrast with the conventional CSF culture, which detected bacteria in 2 of 36 samples (5.6%). CONCLUSION Addition of 16S rRNA sequencing to conventional culturing greatly improved the identification of the aetiology of bacterial meningitis compared to culturing of CSF samples alone.
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Affiliation(s)
- Alieke van der Hoeven
- Department of Medical Microbiology, Leiden University Medical Center, Postzone E4-P, Postbus 9600, 2300 RC, Leiden, The Netherlands.
| | - Martha T van der Beek
- Department of Medical Microbiology, Leiden University Medical Center, Postzone E4-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Vincent Bekker
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Erin Meijers
- Department of Medical Microbiology, Leiden University Medical Center, Postzone E4-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Marco J R Ivens
- Department of Medical Microbiology, Leiden University Medical Center, Postzone E4-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Els Wessels
- Department of Medical Microbiology, Leiden University Medical Center, Postzone E4-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Aloysius C M Kroes
- Department of Medical Microbiology, Leiden University Medical Center, Postzone E4-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Stefan A Boers
- Department of Medical Microbiology, Leiden University Medical Center, Postzone E4-P, Postbus 9600, 2300 RC, Leiden, The Netherlands.
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Gunti S, Nair V, Kannan Loganathan P. Reference range for cerebrospinal fluid values in neonates: 5-year retrospective study. J Matern Fetal Neonatal Med 2022; 35:10584-10590. [PMID: 36310086 DOI: 10.1080/14767058.2022.2139172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Cerebro spinal fluid (CSF) parameters (white blood cell count, protein, glucose) in the diagnosis of neonatal bacterial meningitis. OBJECTIVES To report the reference range of CSF parameters (white blood cell count, protein, glucose) in both term and preterm infants. METHODS This was a single center retrospective study over a period of 5 years (2015-2020). We included infants aged 0-3 months admitted to the neonatal unit and infants ≤28 days attending pediatric acute care and who underwent Lumbar Puncture. We excluded infants with evidence of CSF bacteremia, viral infection and traumatic lumbar puncture defined as CSF Red Blood Cell >500 cells/µL. Clinical, demographic, and microbiological data were collected from the hospital database. The study was approved by ethics committee. RESULTS We identified a total of 518 CSF samples, with 232 CSF samples available for final analysis. 54% of excluded samples were traumatic. Median birth gestation and birth weight of the study cohort were 38 (IQR 35-40) weeks and 3030 (IQR 1965-3565) grams respectively. Median RBC, WBC count, protein and glucose were 15 (IQR 3-85)/µL, 3(IQR 0-8.5)/µL, 0.72 (0.53-1.06) g/L and 2.8 (2.4-3.3) mmol/L respectively. There was no difference in CSF WBC cell count between preterm and term infants. Higher CSF protein content was noted in preterm infants and infants in the first 7 days of life. Use of antibiotics prior to LP was associated with higher CSF protein. Presence of any CSF RBC (including <500 cells/µL) influenced the CSF WBC count and protein content. CONCLUSION We have provided a reference range of CSF parameters in neonates without meningitis. CSF WBC count between preterm and term infants were similar with higher CSF protein content in preterm infants and for infants in the first seven days of life. Presence of any CSF RBC influenced CSF parameters.
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Affiliation(s)
- Swathi Gunti
- Neonatal Unit, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Vrinda Nair
- Neonatal Unit, James Cook University Hospital, Middlesbrough, United Kingdom.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Prakash Kannan Loganathan
- Neonatal Unit, James Cook University Hospital, Middlesbrough, United Kingdom.,Clinical Academic office, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,Department of Physics, University of Durham, Durham, United Kingdom
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Cerebrospinal Fluid Polymerase Chain Reaction in the Diagnosis of Neonatal Bacterial Meningitis: A Single-Center Experience From Vietnam. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2669-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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6
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Ikumapayi UN, Hill PC, Hossain I, Olatunji Y, Ndiaye M, Badji H, Manjang A, Salaudeen R, Ceesay L, Adegbola RA, Greenwood BM, Mackenzie GA. Childhood meningitis in rural Gambia: 10 years of population-based surveillance. PLoS One 2022; 17:e0265299. [PMID: 35947593 PMCID: PMC9365145 DOI: 10.1371/journal.pone.0265299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background The introduction in many countries of conjugate vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis has led to significant reductions in acute bacterial meningitis (ABM) in children. However, recent population-based data on ABM in sub-Saharan Africa are limited. Methods Population-based surveillance for meningitis was carried out in a rural area of The Gambia under demographic surveillance from 2008 to 2017, using standardised criteria for referral, diagnosis and investigation. We calculated incidence using population denominators. Results We diagnosed 1,666 patients with suspected meningitis and collected cerebrospinal fluid (n = 1,121) and/or blood (n = 1,070) from 1,427 (88%) of cases. We identified 169 cases of ABM, 209 cases of suspected non-bacterial meningitis (SNBM) and 1,049 cases of clinically suspected meningitis (CSM). The estimated average annual incidence of ABM was high at 145 per 100,000 population in the <2-month age group, 56 per 100,000 in the 2–23-month age group, but lower at 5 per 100,000 in the 5–14-year age group. The most common causes of ABM were Streptococcus pneumoniae (n = 44), Neisseria meningitidis (n = 42), and Gram-negative coliform bacteria (n = 26). Eighteen of 22 cases caused by pneumococcal serotypes included in PCV13 occurred prior to vaccine introduction and four afterwards. The overall case fatality ratio for ABM was 29% (49/169) and was highest in the <2-month age group 37% (10/27). The case fatality ratio was 8.6% (18/209) for suspected non-bacterial meningitis and 12.8% (134/1049) for clinically suspected meningitis cases. Conclusions Gambian children continue to experience substantial morbidity and mortality associated with suspected meningitis, especially acute bacterial meningitis. Such severely ill children in sub-Saharan Africa require improved diagnostics and clinical care.
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Affiliation(s)
- Usman N. Ikumapayi
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- * E-mail:
| | - Philip C. Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Ilias Hossain
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Yekini Olatunji
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Malick Ndiaye
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Henry Badji
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ahmed Manjang
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Rasheed Salaudeen
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Lamin Ceesay
- Ministry of Health, Gambia Government, Banjul, The Gambia
| | - Richard A. Adegbola
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- RAMBICON, Immunisation & Global Health Consulting, Lekki, Lagos, Nigeria
| | | | - Grant A. Mackenzie
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Murdoch Children’s Research Institute, Parkville, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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7
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Chen Y, Huang S, Zhou L, Wang X, Yang H, Li W. Coronavirus Disease 2019 (COVID-19): Emerging detection technologies and auxiliary analysis. J Clin Lab Anal 2022; 36:e24152. [PMID: 34894011 PMCID: PMC8761422 DOI: 10.1002/jcla.24152] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/09/2021] [Accepted: 11/18/2021] [Indexed: 12/11/2022] Open
Abstract
The ongoing COVID-19 pandemic constitutes a new challenge for public health. Prevention and control of infection have become urgent and serious issues. To meet the clinical demand for higher accuracy of COVID-19 detection, the development of fast and efficient methods represents an important step. The most common methods of COVID-19 diagnosis, relying on real-time fluorescent quantitative PCR(RT-qPCR), computed tomography, and new-generation sequencing technologies, have a series of advantages, especially for early diagnosis and screening. In addition, joint efforts of researchers all over the world have led to the development of other rapid detection methods with high sensitivity, ease of use, cost-effectiveness, or allowing multiplex analysis based on technologies such as dPCR, ELISA, fluorescence immunochromatography assay, and the microfluidic detection chip method. The main goal of this review was to provide a critical discussion on the development and application of these different analytical methods, which based on etiology, serology, and molecular biology, as well as to compare their respective advantages and disadvantages. In addition to these methods, hematology and biochemistry, as well as auxiliary analysis based on pathological anatomy, ultrasonography, and cytokine detection, will help understand COVID-19 pathogenesis. Together, these technologies may promote and open new windows to unravel issues surrounding symptomatic and asymptomatic COVID-19 infections and improve clinical strategies toward reducing mortality.
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Affiliation(s)
- Ying Chen
- School of Medical Technology, Xuzhou Medical University, Xuzhou, China
| | - Shengxiong Huang
- School of Food and Biological Engineering, Hefei University of Technology, Hefei, China
| | - Liuyan Zhou
- School of Anesthesiology, Xuzhou Medical University, Xuzhou, China
| | - Xin Wang
- Centralized and Point of Care Solutions & Molecular Diagnostics, Roche Diagnostics (Shanghai) Limited, Shanghai, China
| | - Huan Yang
- School of Medical Technology, Xuzhou Medical University, Xuzhou, China
| | - Wenqing Li
- School of Medical Technology, Xuzhou Medical University, Xuzhou, China
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8
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Ali SA, Taj MK, Ali SH. Antimicrobial Resistance Pattern of Bacterial Meningitis Among Patients in Quetta, Pakistan. Infect Drug Resist 2021; 14:5107-5120. [PMID: 34880636 PMCID: PMC8646111 DOI: 10.2147/idr.s339231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/23/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction Bacterial meningitis (BM) is a lethal infectious disease that persists as a substantial cause of morbidity and mortality. The antimicrobial drug resistance in BM pathogens poses a major threat to the community while raising challenges for clinicians. For the first time, we elucidate the incidence rate of BM and its drug resistance among the population of Quetta, Balochistan. Methods A cross-sectional study was conducted (from January 2018 to March 2021) among meningitis patients admitted to government hospitals in Quetta. The cerebrospinal fluid (CSF) specimen was collected and processed for microbiological and cytological analysis. Bacterial isolates were identified and confirmed using phylogenetic analysis of the 16S rRNA gene. Results We found 35.9% (321/894) confirmed cases of BM among the population of Quetta, Balochistan. The identified bacterial isolates comprised Streptococcus pneumoniae 14.7% (130/894), Staphylococcus aureus 6.9% (61/894), Neisseria meningitidis 5.7% (51/894), Haemophilus influenzae 2.5% (22/894), Escherichia coli 4.5% (40/894), and Klebsiella pneumoniae 1.9% (17/894). A high percentage in male patients of 20.8% (186/894) was identified as compared to female patients of 15.1% (135/894). Extreme age groups such as infants (age range: 1 month to 1 year) and adults (age range: 61 years to 99 years) with low immunity were critically affected by BM. Clinical parameters such as abnormal CSF appearance, pH, and high WBCs in BM patients with endocarditis as the underlying disease were significantly at elevated risk of fatal outcome. 16S rRNA gene phylogenetic analysis confirmed the evolutionary similarity of isolated strains with prevailing pathogenic strains in Asia. Furthermore, age was identified as a significant risk factor for clinical outcomes. Conclusion The majority of the identified BM patients belonged to rural areas with limited health-care facilities and paramedic staff. The high case fatality rate 11% demonstrates increased antibiotic resistance among BM isolates, thereby stimulating its devastation in underdeveloped regions. Timely detection and intensive treatment of BM may improve critical outcomes in patients.
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Affiliation(s)
- Syeda Ayesha Ali
- Center for Advanced Studies in Vaccinology and Biotechnology (CASVAB), University of Balochistan, Quetta, Pakistan.,Department of Biochemistry, Sardar Bahadur Khan Women's University (SBKWU), Quetta, Pakistan
| | - Muhammad Kamran Taj
- Center for Advanced Studies in Vaccinology and Biotechnology (CASVAB), University of Balochistan, Quetta, Pakistan
| | - Syeda Hafsa Ali
- Department of Microbiology, Balochistan University of Information Technology, Engineering, and Management Sciences (BUITEMS), Quetta, Pakistan
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Chen Y, Wang Z, Shi Q, Huang S, Yu T, Zhang L, Yang H. Multiplex PCR method for simultaneous detection of five pathogenic bacteria closely related to foodborne diseases. 3 Biotech 2021; 11:219. [PMID: 33968564 DOI: 10.1007/s13205-021-02759-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/27/2021] [Indexed: 11/27/2022] Open
Abstract
In this study, we describe a multiplex PCR method for the detection of five food-relevant virulence pathogenicity genes of intestinal pathogens. Five pairs of primers were designed based on nuc gene for Staphylococcus aureus, hlyA gene of Listeria monocytogenes, ipaH gene of Shigella flexneri, lysP gene of Yersinia enterocolitica and tpi gene of Clostridium difficile. Conditions were optimized to amplify fragments of those genes simultaneously in one PCR amplification. After developing and optimizing the multiplex PCR reaction system, the specificity and sensitivity of the multiple PCR assays were evaluated. The optimized program is also applied to retail meat for testing. The result indicated that when the annealing temperature was 54 °C and the primer concentrations of S. aureus, L. monocytogenes, S. flexneri, Y. enterocolitica and C. difficile are 10, 10, 5, 3 and 2 μM, the five strains could expand 484, 345, 204, 156, 88 bp of clear fragments, respectively. So was the multiple PCR in artificially contaminated beef produce. All cultures were cultured and separated by traditional methods. The multiplex PCR method offers a rapid, simple, and accurate identification of pathogens and could be used in food safety investigations, clinical diagnosis as well as for the surveillance of the spreading determinants of pathogens in epidemiological studies.
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Affiliation(s)
- Ying Chen
- School of Medical Technology, Xuzhou Medical University, No. 209 Tongshan Road, Yunlong District, Xuzhou, 221004 China
| | - Zixuan Wang
- School of Medical Technology, Xuzhou Medical University, No. 209 Tongshan Road, Yunlong District, Xuzhou, 221004 China
| | - Qiaozhen Shi
- School of Medical Technology, Xuzhou Medical University, No. 209 Tongshan Road, Yunlong District, Xuzhou, 221004 China
| | - Shengxiong Huang
- School of Food and Biological Engineering, Hefei University of Technology, Hefei, 230009 China
| | - Taotao Yu
- School of Medical Technology, Xuzhou Medical University, No. 209 Tongshan Road, Yunlong District, Xuzhou, 221004 China
| | - Linyan Zhang
- School of Medical Technology, Xuzhou Medical University, No. 209 Tongshan Road, Yunlong District, Xuzhou, 221004 China
| | - Huan Yang
- School of Medical Technology, Xuzhou Medical University, No. 209 Tongshan Road, Yunlong District, Xuzhou, 221004 China
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Detection of Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae in Culture Negative Cerebrospinal Fluid Samples from Meningitis Patients Using a Multiplex Polymerase Chain Reaction in Nepal. Infect Dis Rep 2021; 13:173-180. [PMID: 33804301 PMCID: PMC7930938 DOI: 10.3390/idr13010019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/02/2021] [Accepted: 02/07/2021] [Indexed: 11/17/2022] Open
Abstract
The rapid identification of bacteria causing meningitis is crucial as delays in the treatment increase mortality rate. Though considered as the gold standard for the laboratory diagnosis of bacterial meningitis, culture might give false negative results in a case of patients under antibiotics prior to lumbar puncture. This study aimed to detect Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae by a multiplex polymerase chain reaction (PCR) in culture-negative cerebrospinal fluid samples collected from clinically suspected meningitis cases attending different hospitals in Kathmandu, Nepal from January 2017 to December 2019. S. pneumoniae, N. meningitidis and H. influenzae were detected in 8.59% (33/384) of the specimens by PCR and 7.55% (29/384) of the specimens by culture. Correlation between culture and PCR of the same sample was good (Spearman's rho correlation coefficient = 0.932). However, the difference in positivity between culture and PCR was statistically not significant (p value > 0.05). In four specimens, culture could not detect any of the targeted bacteria whereas PCR could detect presence of H. influenzae. PCR increases the diagnostic yield for bacterial meningitis. PCR may be considered as an adjunctive test for establishing the cause of infection in culture negative clinically suspected meningitis cases.
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11
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Su M, Wang Q, Li D, Wang LL, Wang CY, Wang JL, Zhang Q, Du LY, Liu JY, Xie GC. Prevalence and clinical characteristics of hospitalized children with community-acquired Mycoplasma pneumoniae pneumonia during 2017/2018, Chengde, China. Medicine (Baltimore) 2021; 100:e23786. [PMID: 33592835 PMCID: PMC7870167 DOI: 10.1097/md.0000000000023786] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 11/13/2020] [Indexed: 01/05/2023] Open
Abstract
Community acquired-pneumonia (CAP) has varying causative pathogens and clinical characteristics. This study investigated the prevalence of Mycoplasma pneumoniae (M pneumoniae) and evaluated the clinical characteristics in infected hospitalized children by disease severity.From throat swabs of hospitalized children (5 months to 14 years) with CAP collected between November 2017 and May 2018, M pneumoniae and other CAP pathogens were identified using polymerase chain reaction (PCR). Differences in clinical and laboratory test data were compared between severe and mild case groups.Of 333 hospitalized children enrolled, 221/333 (66.4%) tested positive for M pneumoniae and 24/221 (10.9%) patients were (n = 9, aged <5 years vs n = 15, ≥5 years) single infection by PCR, however, only 170/333 (51.1%) patients were presented with M pneumoniae IgM-positive. M pneumoniae detection rate by PCR was higher than by immunoglobulin (IgM) serology. In 123/221 (55.7%) M pneumoniae infected patients, coinfection with bacterial pathogens (n = 61, <5 years vs n = 62, ≥5 years) occurred. Children (aged 3-8 years) had most M pneumoniae infection. Severe M pneumoniae pneumonia (MPP) in children occurred mostly in older age (7 [interquartile ranges {IQR}, 6-8] years; P < .0001), with longer cough days (14 [IQR, 10-19.5] days; P = .002) and hospitalization duration (9.5 [IQR, 7-12.3] days; P < .0001), lower lymphocyte ratio (24.1, [IQR, 20.0-31.1] %; P = .001), higher neutrophils ratio (66.0, [IQR, 60.2-70.3]%; P < .0001), and serum C-reactive protein (CRP) level (3.8, [IQR, 1.3-10.9] mg/L; P = .027).M pneumoniae is the most commonly detected pathogen in CAP. High coinfection prevalence increases diagnosis difficulty by clinically nonspecific characteristics. M pneumoniae detection by PCR with IgM may improve precise and reliable diagnosis of community-acquired MPP.
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Affiliation(s)
- Meng Su
- Department of Pathogenic Biology
| | - Qian Wang
- Department of Respiratory, Children′s Hospital of Hebei Province, Shijiazhuang
| | - Dan Li
- Department of Pathogenic Biology
| | - Ling-Ling Wang
- Department of Preventive Medicine, Chengde Medical University
| | - Chun-Yang Wang
- Clinical Medical College, Xi’an Medical University, Xi’an
| | - Jiang-Li Wang
- Chengde Center for Disease Control and Prevention, Department of Microbiology Laboratory
| | - Qing Zhang
- Chinese Center for Viral Disease Control and Prevention, National Institute for Viral Disease Control and Prevention, Beijing
| | | | - Jian-Ying Liu
- Department of Pediatrics, NO.2 Clinical Teaching Hospital Affiliated to Chengde Medical University, Chengde, China
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12
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Mosadegh M, Asadian R, Emamie AD, Rajabpour M, Najafinasab E, Azarsa M. Impact of Laboratory Methods and Gene Targets on Detection of Streptococcus pneumoniae in Isolates and Clinical Specimens. Rep Biochem Mol Biol 2020; 9:216-222. [PMID: 33178872 DOI: 10.29252/rbmb.9.2.216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Background Timely identification of Streptococcus pneumoniae infections can lead to a decrease in mortality rates. Differentiation of S. pneumoniae from other similar species using traditional culture-based and molecular methods is problematic. In this study, we assessed the efficacy of identifying the blpA and lytA for the detection of S. pneumoniae from isolates and various clinical samples using molecular methods. Methods A total of 440 clinical samples were collected from patients with suspected invasive pneumococcal infections during February 2016 to October 2018. Biochemical tests were used to confirm the dubious colonies on 5% sheep blood agar. Fifty-seven confirmed isolates, 57 culture-positive samples, and 57 culture-negative samples were analyzed for the presence of blpA and lytA using both conventional and real-time PCR. Results All the isolates and culture-positive samples were positive for blpA and lytA by both PCR methods. Of the 57 culture-negative samples, conventional and real-time PCR amplified blpA from six and two samples, and lytA from seven and two samples, respectively. Conclusion The specificity of real-time PCR assay was significantly higher than that of conventional PCR for the identification of S. pneumoniae. In addition, it is suggested that respiratory secretions are not suitable specimen for direct diagnosis of pneumococcal infections.
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Affiliation(s)
- Mehrdad Mosadegh
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Rozita Asadian
- Department of Medical Laboratory Sciences, School of Paramedicine, Guilan University of Medical Sciences, Langeroud, Iran
| | - Amir Darb Emamie
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Rajabpour
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elmira Najafinasab
- Department of Microbiology, Khoy University of Medical Sciences, Khoy, Iran
| | - Mohammad Azarsa
- Department of Microbiology, Khoy University of Medical Sciences, Khoy, Iran
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13
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Pelkonen T, Urtti S, Dos Anjos E, Cardoso O, de Gouveia L, Roine I, Peltola H, von Gottberg A, Kyaw MH. Aetiology of bacterial meningitis in infants aged <90 days: Prospective surveillance in Luanda, Angola. Int J Infect Dis 2020; 97:251-257. [PMID: 32534141 DOI: 10.1016/j.ijid.2020.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite effective antibiotics and vaccines, bacterial meningitis (BM) remains one of the leading causes of morbidity and mortality in young infants worldwide. Data from Africa on the aetiology and antibiotic susceptibility are scarce. OBJECTIVE To describe the aetiology of BM in Angolan infants <90 days of age. METHODS A prospective, observational, single-site study was conducted from February 2016 to October 2017 in the Paediatric Hospital of Luanda. All cerebrospinal fluid samples (CSF) from infants aged <90 days with suspected BM or neonatal sepsis were assessed. The local laboratory performed microscopy, chemistry, culture, and susceptibility testing. PCR for vaccine-preventable pathogens was performed in Johannesburg, South Africa. RESULTS Of the 1287 infants, 299 (23%) had confirmed or probable BM. Of the 212 (16%) identified bacterial isolates from CSF, the most common were Klebsiella spp (30 cases), Streptococcus pneumoniae (29 cases), Streptococcus agalactiae (20 cases), Escherichia coli (17 cases), and Staphylococcus aureus (11 cases). A fifth of pneumococci (3/14; 21%) showed decreased susceptibility to penicillin, whereas methicillin-resistant S. aureus (MRSA) was encountered in 4/11 cases (36%). Of the gram-negative isolates, 6/45 (13%) were resistant to gentamicin and 20/58 (34%) were resistant to third-generation cephalosporins. Twenty-four percent (33/135) of the BM cases were fatal, but this is likely an underestimation. CONCLUSIONS BM was common among infants <90 days of age in Luanda. Gram-negative bacteria were predominant and were often resistant to commonly used antibiotics. Continued surveillance of the antibiogram is pivotal to detect potential changes without delay.
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Affiliation(s)
- Tuula Pelkonen
- Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland; Hospital Pediátrico David Bernardino (HPDB), Luanda, Angola.
| | - Suvi Urtti
- Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
| | | | - Ondina Cardoso
- Hospital Pediátrico David Bernardino (HPDB), Luanda, Angola.
| | - Linda de Gouveia
- Centre for Respiratory Disease and Meningitis (CRDM), National Institute for Communicable Diseases (NICD), Division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa.
| | - Irmeli Roine
- Faculty of Medicine, University Diego Portales, Santiago, Chile.
| | - Heikki Peltola
- Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
| | - Anne von Gottberg
- Centre for Respiratory Disease and Meningitis (CRDM), National Institute for Communicable Diseases (NICD), Division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Moe H Kyaw
- Sanofi Pasteur, Epidemiology, Swiftwater, PA, USA.
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14
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Abstract
Infectious meningitis can be caused by viral, bacterial or fungal pathogens. Despite widely available treatments, many types of infectious meningitis are still associated with significant morbidity and mortality. Delay in diagnosis contributes to poor outcomes. Cerebrospinal fluid cultures have been used traditionally but are time intensive and sensitivity is decreased by empiric treatment prior to culture. More rapid techniques such as the cryptococcal lateral flow assay (IMMY), GeneXpert MTB/Rif Ultra (Cepheid) and FilmArray multiplex-PCR (Biofire) are three examples that have drastically changed meningitis diagnostics. This review will discuss a holistic approach to diagnosing bacterial, mycobacterial, viral and fungal meningitis.
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Affiliation(s)
- Victoria Poplin
- Department of Medicine, University of Kansas, Kansas City, KS 66160, USA
| | - David R Boulware
- Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Nathan C Bahr
- Division of Infectious Diseases, Department of Medicine, University of Kansas, Kansas City, KS 66160, USA
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15
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Detection of pathogenic microorganisms from bloodstream infection specimens using TaqMan array card technology. Sci Rep 2018; 8:12828. [PMID: 30150783 PMCID: PMC6110752 DOI: 10.1038/s41598-018-31200-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/14/2018] [Indexed: 12/28/2022] Open
Abstract
Bloodstream infections (BSIs) are often life-threatening, and rapid identification is critical. Here, we developed a TaqMan array card (TAC) assay to detect pathogens in BSI specimens. The TAC included 30 primer/probe pairs targeting 27 species and 3 controls. Reverse transcription and 0.1% blue dextran 2000 increased the TAC assay efficiency. The primer/probe pairs had a limit of detection of 100–102 CFU/mL and a specificity of 100%. For whole blood specimens, the TAC assay showed a sensitivity and specificity of 79.4% and 99.69%, respectively. For blood culture samples, the TAC assay showed a sensitivity and specificity of 100% and 99.67%, respectively. The TAC assay could be a promising method for early detection of bloodstream infection.
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16
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Higgins O, Clancy E, Forrest MS, Piepenburg O, Cormican M, Boo TW, O'Sullivan N, McGuinness C, Cafferty D, Cunney R, Smith TJ. Duplex recombinase polymerase amplification assays incorporating competitive internal controls for bacterial meningitis detection. Anal Biochem 2018; 546:10-16. [PMID: 29378166 DOI: 10.1016/j.ab.2018.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/16/2018] [Accepted: 01/18/2018] [Indexed: 10/18/2022]
Abstract
Recombinase polymerase amplification (RPA) is an isothermal nucleic acid amplification technology that provides rapid and robust infectious disease pathogen detection, ideal for point-of-care (POC) diagnostics in disease-prevalent low-resource countries. We have developed and evaluated three duplex RPA assays incorporating competitive internal controls for the detection of leading bacterial meningitis pathogens. Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae singleplex RPA assays were initially developed and evaluated, demonstrating 100% specificity with limits of detection of 4.1, 8.5 and 3.9 genome copies per reaction, respectively. Each assay was further developed into internally controlled duplex RPA assays via the incorporation of internal amplification control templates. Clinical performance of each internally controlled duplex RPA assay was evaluated by testing 64 archived PCR-positive clinical samples. Compared to real-time PCR, all duplex RPA assays demonstrated 100% diagnostic specificity, with diagnostic sensitivities of 100%, 86.3% and 100% for the S. pneumoniae, N. meningitidis and H. influenzae assays, respectively. This study details the first report of internally controlled duplex RPA assays for the detection of bacterial meningitis pathogens: S. pneumoniae, N. meningitidis and H. influenzae. We have successfully demonstrated the clinical diagnostic utility of each duplex RPA assay, introducing effective diagnostic technology for POC bacterial meningitis identification in disease-prevalent developing countries.
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Affiliation(s)
- Owen Higgins
- Molecular Diagnostics Research Group, School of Natural Sciences and National Centre for Biomedical Engineering Science, National University of Ireland, Galway, Ireland.
| | - Eoin Clancy
- Molecular Diagnostics Research Group, School of Natural Sciences and National Centre for Biomedical Engineering Science, National University of Ireland, Galway, Ireland
| | | | | | - Martin Cormican
- School of Medicine, Galway University Hospital, National University of Ireland, Galway, Ireland
| | - Teck Wee Boo
- School of Medicine, Galway University Hospital, National University of Ireland, Galway, Ireland
| | - Nicola O'Sullivan
- Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Temple Street, Dublin, Ireland
| | - Claire McGuinness
- Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Temple Street, Dublin, Ireland
| | - Deirdre Cafferty
- Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Temple Street, Dublin, Ireland
| | - Robert Cunney
- Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Temple Street, Dublin, Ireland
| | - Terry J Smith
- Molecular Diagnostics Research Group, School of Natural Sciences and National Centre for Biomedical Engineering Science, National University of Ireland, Galway, Ireland
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Nanotheranostic approaches for management of bloodstream bacterial infections. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2017; 13:329-341. [DOI: 10.1016/j.nano.2016.09.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/30/2016] [Accepted: 09/16/2016] [Indexed: 12/14/2022]
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18
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Azzari C, Nieddu F, Moriondo M, Indolfi G, Canessa C, Ricci S, Bianchi L, Serranti D, Poggi GM, Resti M. Underestimation of Invasive Meningococcal Disease in Italy. Emerg Infect Dis 2016; 22:469-75. [PMID: 26890305 PMCID: PMC4766889 DOI: 10.3201/eid2203.150928] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Underestimation is attributable to misdiagnosis, especially in fatal cases, and use of insufficiently sensitive laboratory methods. Knowing the incidence of invasive meningococcal disease (IMD) is essential for planning appropriate vaccination policies. However, IMD may be underestimated because of misdiagnosis or insufficiently sensitive laboratory methods. Using a national molecular surveillance register, we assessed the number of cases misdiagnosed and diagnoses obtained postmortem with real-time PCR (rPCR), and we compared sensitivity of rPCR versus culture-based testing. A total of 222 IMD cases were identified: 11 (42%) of 26 fatal cases had been misdiagnosed or undiagnosed and were reclassified as IMD after rPCR showed meningococcal DNA in all available specimens taken postmortem. Of the samples tested with both rPCR and culture, 58% were diagnosed by using rPCR alone. The underestimation factor associated with the use of culture alone was 3.28. In countries such as Italy, where rPCR is in limited use, IMD incidence may be largely underestimated; thus, assessments of benefits of meningococcal vaccination may be prone to error.
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19
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Abstract
Among 831 cases of neonatal bacterial meningitis occurring from 2001 to 2013, Neisseria meningitidis was the third most frequent bacterial species found. All cases occurred only in term neonates and were mainly late onset. Serogroup B accounted for 78% of cases. At diagnosis, 27% of cases had at least one sign of disease severity. All strains were susceptible to cefotaxime, but 12% showed intermediate susceptibility to penicillin G and to aminopenicillin.
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20
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Rapid Detection of Streptococcus agalactiae Infection Using a Loop-Mediated Isothermal Amplification Method. Jundishapur J Microbiol 2016. [DOI: 10.5812/jjm.37171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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21
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Başpınar EÖ, Dayan S, Bekçibaşı M, Tekin R, Ayaz C, Deveci Ö, Hoşoğlu S. Comparison of culture and PCR methods in the diagnosis of bacterial meningitis. Braz J Microbiol 2016; 48:232-236. [PMID: 27793541 PMCID: PMC5470338 DOI: 10.1016/j.bjm.2016.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/04/2016] [Accepted: 06/23/2016] [Indexed: 12/04/2022] Open
Abstract
Our aim in this study is to compare the standard culture method with the multiplex PCR and the Speed-Oligo® Bacterial Meningitis Test (SO-BMT) – a hybridization-based molecular test method – during the CSF examination of the patients with the pre-diagnosis of acute bacterial meningitis. For the purposes of this study, patients with acute bacterial meningitis treated at the Dicle University Medical Faculty Hospital, Infectious Diseases and Clinical Microbiology Clinic between December 2009 and April 2012 were retrospectively evaluated. The diagnosis of bacterial meningitis was made based on the clinical findings, laboratory test anomalies, CSF analysis results, and the radiological images. Growth was observed in the CSF cultures of 10 out of the 57 patients included in the study (17.5%) and Streptococcus pneumoniae was isolated in all of them. The CSF samples of 34 patients (59.6%) were positive according to the SO-BMT and S. pneumoniae was detected in 33 of the samples (97.05%), while Neisseria meningitidis was found in 1 sample (2.95%). In a total of 10 patients, S. pneumoniae was both isolated in the CSF culture and detected in the SO-BMT. The culture and the SO-BMT were negative in 23 of the CSF samples. There was no sample in which the CSF culture was positive although the SO-BMT was negative. While SO-BMT seems to be a more efficient method than bacterial culturing to determine the pathogens that most commonly cause bacterial meningitis in adults, further studies conducted on larger populations are needed in order to assess its efficiency and uses.
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Affiliation(s)
- Emel Ödemiş Başpınar
- Celal Ertuğ Etimesgut State Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Saim Dayan
- Dicle University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakır, Turkey
| | - Muhammed Bekçibaşı
- Bismil State Hospital, Department of Infectious Diseases and Clinical Microbiology, Diyarbakır, Turkey.
| | - Recep Tekin
- Dicle University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakır, Turkey
| | - Celal Ayaz
- Dicle University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakır, Turkey
| | - Özcan Deveci
- Dicle University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakır, Turkey
| | - Salih Hoşoğlu
- Fatih University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
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22
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Identification of Common Bacterial Pathogens Causing Meningitis in Culture-Negative Cerebrospinal Fluid Samples Using Real-Time Polymerase Chain Reaction. Int J Microbiol 2016; 2016:4197187. [PMID: 27563310 PMCID: PMC4983665 DOI: 10.1155/2016/4197187] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/18/2016] [Accepted: 07/04/2016] [Indexed: 12/04/2022] Open
Abstract
Background. Meningitis is a serious communicable disease with high morbidity and mortality rates. It is an endemic disease in Egypt caused mainly by Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. In some settings, bacterial meningitis is documented depending mainly on positive cerebrospinal fluid (CSF) culture results or CSF positive latex agglutination test, missing the important role of prior antimicrobial intake which can yield negative culture and latex agglutination test results. This study aimed to utilize molecular technology in order to diagnose bacterial meningitis in culture-negative CSF samples. Materials and Methods. Forty culture-negative CSF samples from suspected cases of bacterial meningitis were examined by real-time polymerase chain reaction (real-time PCR) for the presence of lytA, bexA, and ctrA genes specific for Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, respectively. Results. Positive real-time PCR results for Streptococcus pneumoniae were detected in 36 (90%) of culture-negative CSF samples while no positive results for Haemophilus influenzae or Neisseria meningitidis were detected. Four (10%) samples were negative by real-time PCR for all tested organisms. Conclusion. The use of molecular techniques as real-time PCR can provide a valuable addition to the proportion of diagnosed cases of bacterial meningitis especially in settings with high rates of culture-negative results.
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Farahani H, Ghaznavi-Rad E, Mondanizadeh M, MirabSamiee S, Khansarinejad B. Specific detection of common pathogens of acute bacterial meningitis using an internally controlled tetraplex-PCR assay. Mol Cell Probes 2016; 30:261-265. [PMID: 27401970 DOI: 10.1016/j.mcp.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/06/2016] [Accepted: 07/06/2016] [Indexed: 11/29/2022]
Abstract
Accurate and timely diagnosis of acute bacterial meningitis is critical for antimicrobial treatment of patients. Although PCR-based methods have been widely used for the diagnosis of acute meningitis caused by bacterial pathogens, the main disadvantage of these methods is their high cost. This disadvantage has hampered the widespread use of molecular assays in many developing countries. The application of multiplex assays and "in-house" protocols are two main approaches that can reduce the overall cost of a molecular test. In the present study, an internally controlled tetraplex-PCR was developed and validated for the specific detection of Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae in cerebrospinal fluid (CSF) samples. The analysis of a panel of other human pathogens showed no cross-reactivity in the assay. The analytical sensitivity of the in-house assay was 792.3 copies/ml, when all three bacteria were presentin the specimens. This value was calculated as 444.5, 283.7, 127.8 copies/ml when only S. pneumoniae, N. meningitidis and H. influenzae, respectively, were present. To demonstrate the diagnostic performance of the assay, a total of 150 archival CSF samples were tested and compared with a commercial multiplex real-time PCR kit. A diagnostic sensitivity of 92.8% and a specificity of 95.1% were determined for the present tetraplex-PCR assay. The results indicate that the established method is sensitive, specific and cost-effective, and can be used particularly in situations where the high cost of commercial kits prevents the use of molecular methods for the diagnosis of bacterial meningitis.
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Affiliation(s)
- Hamidreza Farahani
- Department of Microbiology and Immunology, Arak University of Medical Sciences, Arak, Iran
| | - Ehsanollah Ghaznavi-Rad
- Department of Microbiology and Immunology, Arak University of Medical Sciences, Arak, Iran; Molecular and Medicine Research Center, Arak University of Medical Sciences, Arak, Iran
| | - Mahdieh Mondanizadeh
- Molecular and Medicine Research Center, Arak University of Medical Sciences, Arak, Iran; Department of Biotechnology and Molecular Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Siamak MirabSamiee
- Food and Drug Laboratory Research Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Behzad Khansarinejad
- Department of Microbiology and Immunology, Arak University of Medical Sciences, Arak, Iran; Molecular and Medicine Research Center, Arak University of Medical Sciences, Arak, Iran.
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24
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Langley G, Besser J, Iwamoto M, Lessa FC, Cronquist A, Skoff TH, Chaves S, Boxrud D, Pinner RW, Harrison LH. Effect of Culture-Independent Diagnostic Tests on Future Emerging Infections Program Surveillance. Emerg Infect Dis 2016; 21:1582-8. [PMID: 26291736 PMCID: PMC4550165 DOI: 10.3201/eid2109.150570] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The Centers for Disease Control and Prevention Emerging Infections Program (EIP) network conducts population-based surveillance for pathogens of public health importance. Central to obtaining estimates of disease burden and tracking microbiological characteristics of these infections is accurate laboratory detection of pathogens. The use of culture-independent diagnostic tests (CIDTs) in clinical settings presents both opportunities and challenges to EIP surveillance. Because CIDTs offer better sensitivity than culture and are relatively easy to perform, their use could potentially improve estimates of disease burden. However, changes in clinical testing practices, use of tests with different sensitivities and specificities, and changes to case definitions make it challenging to monitor trends. Isolates are still needed for performing strain typing, antimicrobial resistance testing, and identifying other molecular characteristics of organisms. In this article, we outline current and future EIP activities to address issues associated with adoption of CIDTs, which may apply to other public health surveillance.
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Ye Q, Shao WX, Shang SQ, Shen HQ, Chen XJ, Tang YM, Yu YL, Mao JH. Clinical Value of Assessing Cytokine Levels for the Differential Diagnosis of Bacterial Meningitis in a Pediatric Population. Medicine (Baltimore) 2016; 95:e3222. [PMID: 27043692 PMCID: PMC4998553 DOI: 10.1097/md.0000000000003222] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 11/26/2022] Open
Abstract
We performed a prospective observational study to evaluate the utility of measuring inflammatory cytokine levels to discriminate bacterial meningitis from similar common pediatric diseases. Inflammatory cytokine levels and other cerebrospinal fluid (CSF) physicochemical indicators were evaluated in 140 patients who were diagnosed with bacterial meningitis via microbiological culture or PCR assay. The CSF concentrations of interleukin (IL)-6 and IL-10, CSF/blood IL-6 and IL-10 ratios, CSF white blood cell count, and CSF micro total protein were significantly elevated in bacterial meningitis patients compared with healthy children or patients with viral encephalitis, epilepsy, or febrile convulsions (P < 0.001). The area under the curve values for CSF concentrations of IL-6 and IL-10, CSF/blood IL-6 and IL-10 ratios, CSF white blood cell count, and CSF micro total protein to identify bacterial meningitis episodes by receiver-operating characteristic analysis were 0.988, 0.949, 0.995, 0.924, 0.945, and 0.928, respectively. The area under the curve for the combination of CSF IL-6 and CSF/blood IL-6 ratio was larger than that for either parameter alone, and the combination exhibited enhanced specificity and positive predictive value. After effective meningitis treatment, CSF IL-6 levels dropped significantly. These results suggest that CSF IL-6 and CSF/blood IL-6 ratio are good biomarkers in discriminating bacterial meningitis. Evaluating CSF IL-6 and CSF/blood IL-6 ratio in combination can improve diagnostic efficiency. Additionally, CSF IL-6 levels can be used to monitor the effects of bacterial meningitis treatment.
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Affiliation(s)
- Qing Ye
- From the Zhejiang Key Laboratory for Neonatal Diseases (QY, S-QS, H-QS, X-JC, Y-MT, Y-LY, J-HM), The Children's Hospital of Zhejiang University School of Medicine; and Clinical Laboratory (W-XS), Hangzhou First People's Hospital, Hangzhou, China
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The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect 2016; 72:405-38. [PMID: 26845731 DOI: 10.1016/j.jinf.2016.01.007] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/14/2016] [Accepted: 01/23/2016] [Indexed: 02/06/2023]
Abstract
Bacterial meningitis and meningococcal sepsis are rare conditions with high case fatality rates. Early recognition and prompt treatment saves lives. In 1999 the British Infection Society produced a consensus statement for the management of immunocompetent adults with meningitis and meningococcal sepsis. Since 1999 there have been many changes. We therefore set out to produce revised guidelines which provide a standardised evidence-based approach to the management of acute community acquired meningitis and meningococcal sepsis in adults. A working party consisting of infectious diseases physicians, neurologists, acute physicians, intensivists, microbiologists, public health experts and patient group representatives was formed. Key questions were identified and the literature reviewed. All recommendations were graded and agreed upon by the working party. The guidelines, which for the first time include viral meningitis, are written in accordance with the AGREE 2 tool and recommendations graded according to the GRADE system. Main changes from the original statement include the indications for pre-hospital antibiotics, timing of the lumbar puncture and the indications for neuroimaging. The list of investigations has been updated and more emphasis is placed on molecular diagnosis. Approaches to both antibiotic and steroid therapy have been revised. Several recommendations have been given regarding the follow-up of patients.
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28
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Liu XJ, Zhang XL, Han QZ. Establishment of rat pneumococcal meningitis models: a histopathological analysis. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:2242-2248. [PMID: 25973135 PMCID: PMC4396340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 01/23/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to perform a preliminary investigation of the pathogenesis of bacterial meningitis-induced brain injury by establishing rat pneumococcal meningitis models. Infant Wistar rats were intracranially inoculated with different concentrations of Streptococcus pneumoniae. Rats were sacrificed at different time points to observe clinical symptoms and pathological changes in brain tissues. Twenty-four hours after intracranial inoculation with Streptococcus pneumoniae, regardless of high or low concentrations of bacterial inoculation, all rats developed bacterial meningitis with manifestations such as lethargy and seizures. Pathological changes in brain tissues included subarachnoid and intraventricular inflammation, vasodilation and vascular congestion, and cortical neuronal necrosis. The number of rats with seizures, the degree of cerebral vascular disease, and the extent of neuronal damage were associated with the concentration of bacterial inoculum. Thirty days after infection, brain tissue weight significantly reduced. The pathological changes induced by inoculation with pneumococcal meningitis in Wistar rats were similar to those seen in the human brain. The possible mechanisms of brain damage caused by meningitis are cerebrovascular inflammation and disruption of regional cerebral blood flow.
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Affiliation(s)
- Xin-Jie Liu
- Department of Pediatrics, Qilu Hospital, Shandong University107 Wen Hua Xi Road, Jinan 250012, People’s Republic of China
- Brain Science Research Institute, Shandong University107 Wen Hua Xi Road, Jinan 250012, People’s Republic of China
| | - Xiao-Li Zhang
- Department of Pharmacy, Provincial Hospital Affiliated to Shandong University324 Jing Wu Road, Jinan 250021, People’s Republic of China
| | - Qi-Zheng Han
- Department of Respiratory Medicine, Provincial Hospital Affiliated to Shandong University4 Duan Xing Xi Road, Jinan 250021, People’s Republic of China
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