Incidence of bacterial meningitis in Asia using enhanced CSF testing: polymerase chain reaction, latex agglutination and culture

Abstract

To enhance the detection of bacterial meningitis in an East Asian surveillance study, we employed cerebrospinal fluid (CSF) bacterial culture, latex agglutination (LA) and polymerase chain reaction-enzyme immunoassay (PCR-EIA) testing for Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae (Sp). The sensitivity and specificity of CSF PCR-EIA testing was compared to LA and culture. A meningitis case was defined by one positive result for any of the three tests. The sensitivity of H. influenzae CSF PCR-EIA, LA, and culture was 100%, 40% and 57.5% respectively; and for Sp CSF PCR-EIA, LA and culture, the sensitivity was 100%, 58.3% and 66.7%, respectively. Hib and Sp specificity was 100% by each method. CSF PCR-EIA was more sensitive than culture or LA for the detection of Hib and Sp meningitis cases increasing their incidence by 74% and 50% compared to culture respectively. CSF PCR-EIA should be included for the detection of bacterial meningitis in surveillance studies.

Surveillance of Pneumococcal‐Associated Disease among Hospitalized Children in Khanh Hoa Province, Vietnam

“…This additional PCR testing increased overall detection of laboratory-confirmed Hib disease, compared with detection by culture alone. The diagnostic yield by PCR of CSF specimens in this study is consistent with the findings of Kennedy et al [17], who found that PCR to test for Hib and pneumococci in CSF identified additional children who did not receive a diagnosis by either culture or antigen testing.…”

Translational Research to Generate Evidence for Rational and Efficient Introduction of New Vaccines in Developing Countries: The Experience of the International Vaccine Institute

“…This research was undertaken because prospective, population-based studies of Hib meningitis had not been previously done in Asian populations and because of a strong suspicion that Hib meningitis was being underdiagnosed in Asian children, leading to a false impression that this disease was not an important public health problem. To the investigators' surprise, the incidence rates found in the IVI study ( table 3 ) were indeed low in each of the 3 sites [41][42][43] .…”

Haemophilus influenzae type b conjugate vaccines – A South African perspective

“…For these reasons using this case definition, the number of clinical cases, may be significantly underestimated [6]. Various authors have suggested alternative diagnostic and epidemiological means, to overcome this problem, including antigen detection methods [69,70] as well as vaccine-probe study designs [71]. Laboratory parameters focusing on both quantitative and qualitative antibody characteristics have been suggested as markers of protection against disease [72][73][74][75][76].…”