Diagnosis Of Acute Bacterial Meningitis Research Articles

Study of Cerebrospinal Fluid C-reactive Protein in Children with Meningitis between 1 Month and 12 Years of Age

Background: India is a growing nation with few resources and trained workers, especially in terms of outlying infrastructure. As a result, a simple and thorough examination to identify acute bacterial meningitis is required. Regular use of cerebrospinal fluid C-reactive protein (CSF-CRP) in the diagnosis of acute bacterial meningitis may be a quick, accurate, and simple way to diagnose meningitis. As a result, the goal of this study is to examine the specificity, sensitivity, positive and negative predictive values, and diagnostic accuracy of CSF-CRP in the diagnosis of bacterial meningitis. Methodology: In a tertiary care center’s department of pediatrics, between January 2021 and June 2022, a cross-sectional descriptive observational study was carried out. Patients’ demographic data such as age, gender, clinical profile, CSF-CRP, and outcome were recorded. In the current study, each subject underwent a complete examination and comprehensive history before a provisional diagnosis was provided. As part of the diagnostic process, blood and CSF samples were taken. A quantitative immunoturbidometric method was used to determine the level of CSF-CRP. Outcome of the Study: Approximately 130 patients with a history of fever, convulsions, and signs of meningitis were considered, out of which 60 (46.2%) patients were male and 70 (53.8%) patients were female. The majority of cases were found to be positive in the CSF-CRP test, i.e. around 52 (60%), while the distribution based on the CSF culture report showed that 17 cases were positive. The results demonstrated that the CSF-CRP had a sensitivity of 100%, indicating that it correctly identified all positive cases. However, its specificity was 69.02%. Results: Notably, 94.2% of pyogenic meningitis cases had positive CSF-CRP results, while viral meningitis cases had no positive results, and tubercular meningitis had a lower 5.8% positive rate. CSF-CRP was also linked to clinical outcomes, with a significantly higher mortality rate of 9.6% in CSF-CRP positive cases. Conclusion: For the diagnosis of pyogenic meningitis, the culture and Gram stain of CSF is the gold standard. Thus, the early diagnosis of pyogenic meningitis and CSF-CRP is useful and decreases the economic burden and hospital stay of the patients.

Etiology, Clinical Presentation, and Outcomes of Bacterial Meningitis in Adult Patients: A Retrospective Study in Lithuania (2018-2021).

BACKGROUND Bacterial meningitis is a serious and life-threatening condition that requires prompt diagnosis and treatment. This retrospective study aimed to identify causes, presentation, and predictive factors for outcomes of community-acquired bacterial meningitis in 86 adults in Vilnius, Lithuania between 2018 and 2021. MATERIAL AND METHODS We performed a retrospective study of demographic, clinical, and laboratory records of 86 adult patients admitted to Vilnius University Hospital Santaros Clinics with a diagnosis of acute bacterial meningitis during the period of 2018-2021. RESULTS Of 86 patients, 54 (62.79%) were men. The median (Md) age of patients was 58 (range, 18-83) years and the median duration of hospitalization was 20 (range, 3-92) days. Patients were first hospitalized in the Intensive Care Unit (ICU) in 59.3% of cases. The most prevalent concerns were headache (66.28%), febrile temperature (56.98%), general fatigue (53.49%), and confusion/sleepiness (52.33%). Of 57 (66.28%) etiologically confirmed cases, the most prevalent agent was Listeria monocytogenes (29.82%), followed by Streptococcus pneumoniae (28.07%) and Neisseria meningitidis (28.07%). Patients with meningitis caused by L. monocytogenes were the oldest (P=0.003) and had the longest hospitalization (P<0.001). Fatigue was the prominent symptom in patients with meningococcal meningitis (81.2%, P=0.010). Twelve patients (13.95%) have died. Advanced age and low (<100 cells per μL) white blood cell (WBC) count in cerebrospinal fluid (CSF) were associated with lethal outcome, whereas headache was associated with favorable outcome. CONCLUSIONS Clinical characteristics of community-acquired acute bacterial meningitis differ based on etiological factors. Patient age, CSF WBC count, and headache may be significant predictive factors for outcomes of bacterial meningitis.

Diagnosis of Acute Bacterial Meningitis by PCR and the Problem of Isolating the Causative Bacterial Agents by Culture in Burkina Faso

In Burkina Faso, meningitis is epidemic, pneumococcus, meningococcus and Haemophilus influenzae are the most implicated. The aim of this study was to assess the prevalence of ABM characterized by PCR and culture in order to highlight the low yield of the culture. This is a prospective study on 26 health districts of surveillance between 2016 and 2019. The CSF sent were cultured, treated by direct PCR, i.e. from CSF without DNA extraction at the National Meningitis Reference Laboratory of Burkina Faso and at the CDC Atlanta. Several series of direct PCR were carried out for species diagnosis (lytA, sodC and hpd), serotyping of meningococcus and serotyping of pneumococcus (capsular genes) and Haemophilus influenzae (capsular genes). Two thousand eight hundred and forty-five (2,845) CSF were treated with 701 positives and a positivity rate of 24.75%. Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae represent respectively 39.2%, 51.9% and 8.9%. The strains of Neisseria meningitidis and Streptococcus pneumoniae were sensitive to antibiotics except 3 strains of Neisseria meningitidis, resistant to oxacillin. There is a drop in the positivity rate compared to previous years. Pneumococcus remains in the lead with serotype 1 (more than 50%) despite the introduction of PCV13.

Comparative Analysis of Gram Stain, Culture and Bacterial Antigen Detection in Cerebrospinal Fluid Samples for Laboratory Diagnosis of Acute Bacterial Meningitis in Pediatric Population in A Tertiary Care Hospital

Acute bacterial meningitis (ABM) is a life threatening infection in children, associated with long term complications and high mortality rate.1,2 Gram staining and culture are routinely used for diagnosis of ABM. Antigen detection by latex agglutination can provide prompt results thereby facilitating early initiation of empirical antibiotic treatment. To estimate the proportion of Laboratory confirmed cases among children admitted with clinical suspicion of acute bacterial meningitis in a tertiary care hospital. To compare and analyse the diagnostic efficacy of Culture, Gram stain and antigen detection by Latex agglutination in Cerebrospinal fluid (CSF) samples for laboratory detection of Acute bacterial meningitis. CSF samples from pediatric patients with clinical suspicion of ABM were analysed by Gram stain, culture and Antigen detection by Latex agglutination method. Results were recorded and analysed. Of the 50 clinically suspected cases, 13(26%) were confirmed as Acute bacterial meningitis by laboratory investigations. Among the organisms identified, Streptococcus pneumoniae was the most common isolate in 5(38.46%) cases followed by Neisseria meningitidis, Klebsiella pneumoniae and Acinetobacter baumannii in 2(15.38%) cases each and Escherichia coli and Group B Streptococcus in 1(7.69%) case each. Among the confirmed cases, 7(53%) samples showed culture positivity while Gram stain identified 8(61.53%)cases. Latex agglutination test showed positivity in 9(69.23%) cases. In life threatening infections like acute bacterial meningitis, where early diagnosis and prompt treatment is of utmost importance, Latex agglutination test can provide results within minutes facilitating early initiation of empirical therapy, making it an effective adjunct to gram stain and culture.

Comparison between cerebrospinal fluid biomarkers for differential diagnosis of acute meningitis.

Given the difficulty in the differential diagnosis of acute bacterial meningitis (BM) and viral meningitis (VM), we aimed to compare the ability of cerebrospinal fluid (CSF) biomarkers, such as lactate, glucose, lactate dehydrogenase (LDH), C-reactive protein (CRP), total white blood cell count, and predominance of neutrophils, as single tests to differentiate microbiologically defined acute BM and VM. CSF samples were divided into three groups: BM (n=17), VM (n=14) (both with the etiological agent identified), and normal control groups (n=26). All the biomarkers studied were significantly higher in the BM group than in the VM or control groups (p>0.05). CSF lactate showed the best diagnostic clinical performance characteristics: sensitivity (94.12%), specificity (100%), positive and negative predictive value (100 and 97.56%, respectively), positive and negative likelihood ratio (38.59 and 0.06, respectively), accuracy (98.25%), and AUC (0.97). CSF CRP is excellent for screening BM and VM, as its best feature is its specificity (100%). CSF LDH is not recommended for screening or case-finding. LDH levels were higher in Gram-negative diplococcus than in Gram-positive diplococcus. Other biomarkers were not different between Gram-positive and negative bacteria. The highest level of agreement between the CSF biomarkers was between CSF lactate and CRP [kappa coefficient, 0.91 (0.79; 1.00)]. All markers showed significant differences between the studied groups and were increased in acute BM. CSF lactate is better than the other biomarkers studied for screening acute BM due to its high specificity.

The Specificity, Sensitivity, and Diagnostic Accuracy of CSF-CRP in the Diagnosis of Acute Bacterial Meningitis- A Hospital-Based Study

Introduction: Bacteria that enter the bloodstream and mobile to the brain cord cause bacterial meningitis. The disease is less frequent in developed countries compared to developing countries. In Bangladesh, bacterial meningitis constitutes 25% and the case fatality rate was 14%. The mortality from meningitis is near 100% in untreated individuals and can still be up to 40% in children who received appropriate antibiotic therapy in developing countries. Aim of the Study: The study aims to investigate the specificity, sensitivity, and diagnostic accuracy of CSF-CRP in the diagnosis of Acute Bacterial Meningitis (ABM). Methods: An observational cross-sectional study was carried out in the Department of Pediatric Medicine, Dhaka Shishu Hospital (DSH), from 01 Jan-2017 to 30 Jun-2017. A total of 100 patients were enrolled in this study following the inclusive criteria. Data were collected using the predesigned semi-structured questionnaire. Verbal consent was taken before recruiting the study population. Completed data forms were reviewed, edited, and processed for computer data entry. Result: Among the study population majority of patients (43, 43.0%) were 0-2 years old. One-third of bacterial meningitis (35,35.0%) occurs commonly at an early age (0-2 years). Out of fifty- seven cases (n=57) of bacterial meningitis, twenty-two cases were culture negative and thirty-five cases were culture positive. In the case of bacterial meningitis, in fifty-one cases (51,89.4%) out of fifty-seven, the CSF CRP test was truly positive, with mean±SD 21.7±10.9, false negative were only six cases (6, 10.5%). In aseptic meningitis thirty-nine cases (39,90.6%) out of forty-three cases, the CSF-CRP test was truly negative, and false positive were four cases (4,9.3%). The sensitivity of CSF CRP in differentiating bacterial meningitis from aseptic meningitis was 89.47%, specificity 90.69%, &amp; diagnostic accuracy was 90%. Conclusion: Bacterial meningitis is fatal and more communal in children under one year of age to sixteen years of age. Increased consciousness and initial gratitude and apposite antibiotic treatment can decrease morbidity and mortality. Diagnostic accuracy can be applied as the initial test for the diagnosis of bacterial meningitis.

Identifying the Importance of Cerebrospinal Fluid C - reactive protein (CSF-CRP) in Establishing a Diagnosis of Acute Bacterial Meningitis

Introduction: Acute meningitis is a major cause of death and disability worldwide. Differentiating bacterial from nonbacterial meningitis is very important in deciding on treatment. Bacterial meningitis is a life-threatening neurological condition and needs prompt parenteral antibiotics, compared to viral and aseptic meningitis which carries relatively better outcomes. Aim of the study: The aim of the study was to identify the importance of the CSF-CRP test in diagnosing acute bacterial meningitis. Methods: This cross-sectional observational study was conducted at the Department of Pediatric Medicine, Dhaka Shishu Hospital, Dhaka, Bangladesh. The study duration was 6 months, from January 2017 to June 2017. A total of 100 children visiting the inpatient department of the hospital were selected for the present study following inclusion and exclusion criteria. Result: 57% were diagnosed as bacterial meningitis cases, while 43% were diagnosed with aseptic meningitis. Among the 57 cases of bacterial meningitis, 61.40% belonged to the youngest age group of 0-2 years, while among the aseptic meningitis cases, 37.21% belonged to the age group of 3-6 years. Total WBC and PBN were significantly higher among the bacterial meningitis cases. The sensitivity of CSF-CRP was 89.47%, specificity 90.69%, accuracy 90%, a positive predictive value of 92.72%, and a negative predictive value of 86.66% in diagnosing bacterial meningitis. Conclusion: The study findings conclude CSF-CRP to be an important prognostic factor and initial testing method in diagnosing acute bacterial meningitis. CSF CRP has high diagnostic accuracy in determining the incidence of acute bacterial meningitis.

Clinical use of multiplex-PCR for the diagnosis of acute bacterial meningitis.

Background and Objectives:Prompt and accurate diagnosis of acute bacterial meningitis (ABM) is critical for patient management. We designed and evaluated two sets of multiplex-PCR assays for the simultaneous detection of six major etiologies of ABM i.e., Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis in one set and Listeria monocytogenes, Streptococcus agalactiae, and Escherichia coli in another set of multiplex-PCR in CSF of patients with suspected ABM.Methods:A total of 113 CSF specimens from patients of all ages having clinical features suggestive of meningitis were tested for bacteriological evidence by Gram’s smear, culture, and our designed multiplex-PCR.Results:Multiplex-PCR assay performed excellently by increasing the overall detection rate by 6% when compared to culture as of total 113 samples tested, 17 (15%) were positive by multiplex-PCR whereas only 9% (10/113) were positive by culture. It detected the DNA in eight culture negative samples revealing the presence of S. pneumoniae in three and other possible bacterial pathogens in five of them. Our assay showed a DNA detection limit of 1 pg/μL. Compared to CSF culture, the sensitivity and specificity of the multiplex-PCR were 90% and 92.2%, respectively.Conclusion:This study accentuates the importance of multiplex-PCR assay that is efficiently fast and reliable for the diagnosis of acute bacterial meningitis that can substantially improve the diagnosis in culture negative cases, especially in patients who were previously started on antimicrobial therapy.

Clinical and laboratory profile of patients with presumptive clinical diagnosis of acute bacterial meningitis and its short-term complications.

Worldwide, one million cases of bacterial meningitis are estimated to occur and 200,000 of them die annually. Case fatality rates vary with age at the time of illness and the species of bacterium causing infection. In view of variable clinical features and complication rates in various studies, the present study was planned to assess the clinical and laboratory profile of patients with acute bacterial meningitis and analyze the therapeutic response and short-term sequelae. This study was conducted in the department of pediatrics at Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak. A total of 50 pediatric patients with signs and symptoms of acute bacterial meningitis who satisfied the inclusion or selection criteria were enrolled in the study. Appropriate statistical tests were applied for analysis and trial registry was done with PGIMS. In the present study, slightly more males (54%) were found than females (46%). The sequelae and mortality were 33.3%, 26.1% and 7.4%, 8.7% in males and females, respectively. There were higher chances of sequelae or mortality in males as compared to females (OR 1.289, 95% CI 0.073-6.11, P > 0.05). Predominant cells were polymorphonuclear (PMN) cells except in >120 months age group where both PMN (50%) and mononuclear (50%) cells were equally visualized. Mean CSF protein was slightly higher in 2-24 months age group. We compared the group with sequelae with the group with no sequelae and found neurological deficit (P < 0.01), and presence of complications (P < 0.01) were significantly associated with sequelae.

Accuracy of Meningitis Bacterial Score (MBS) as an indicator in establishing the diagnosis of acute bacterial meningitis in adults.

Bacterial meningitis persists as a worldwide threat contributing to high mortality and morbidity rate, where differentiating bacterial meningitis from aseptic meningitis is key for better management and outcomes. Hence, this study aimed to assess the Bacterial Meningeal Score (BMS) as a tool for early diagnosis of acute bacterial meningitis. This study employed a retrospective cross-sectional method using medical records of patients with meningitis and meningoencephalitis who were hospitalized at Dr. Soetomo Hospital, from January 2018 to September 2021. Data of demographics, clinical, laboratory and cerebrospinal fluid (CSF) profile and culture were collected. The diagnostic performance of the BMS in diagnosing acute bacterial meningitis was evaluated by its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR +) and negative likelihood ratio (LR -). A total of 128 patients who had been diagnosed with meningitis and meningoencephalitis were included. Out of total patients, 53 samples were diagnosed with acute bacterial meningitis as confirmed by CSF culture. The sensitivity and specificity of BMS with cutoff >2.5 in diagnosing acute bacterial meningitis were 92.4% and 92.0%, respectively with PPV 89.1% and NPV 94.5%. The area under the curve (AUC) of BMS in diagnosing of acute bacterial meningitis was 95.6% (95%CI: 92.3%, 99%). A BMS score of greater than 2.5 indicates a high likelihood of acute bacterial meningitis, whereas a score less than 2.5 indicates a low likelihood.

Thyroid storm : a case of clinical presentation of bacterial meningitis

A 31-year-old woman presented to the emergency room for symptoms that promptly evoked thyrotoxicosis in a dysthyroid patient. The evolution was quickly unfavorable despite the initial specific management of thyrotoxicosis. The search for a cause for the acute decompensation of her thyroid pathology has led to the diagnosis of acute bacterial meningitis. The treatment of the meningitis has quickly improved the patient's condition. This case illustrates the necessity of looking for an acute underlying cause for thyrotoxicosis to not delay the treatment or risk aggravating the case. This clinical case also illustrates the management of thyrotoxicosis, a known but very rare pathology.

The Value of Combined Measuring of the Cerebrospinal Fluid Lactate and ‎Serum Procalcitonin in Diagnosis of Acute Bacterial Meningitis ‎

Backgroundand study aim:The differential diagnosis between bacterial meningitis and aseptic meningitis is a critical clinical issue and ‎searching for reliable and valid markers is required. This work aimed to assess the role of the combined ‎measuring of CSF lactate and serum procalcitonin in the diagnosis of acute bacterial meningitis‎‎‎. Patients and Method:‎A cross-sectional study including 42 meningitis patients was conducted at Zagazig Fever Hospital and Zagazig ‎University Hospitals in the period from November 2018 to June 2019, Patients were divided according to their ‎final diagnosis into two groups; group I included 13 patients with bacterial meningitis ( positive CSF bacterial ‎culture and/or Gram stain ), group II included 29 patients with aseptic meningitis (negative CSF bacterial ‎culture and Gram stain), The data collection sheet included clinical assessments, lumbar puncture with CSF ‎analysis, CSF lactate level testing, and Serum procalcitonin level testing‎‎.‎ Results: One hundred five of house officer participated Serum procalcitonin and CSF lactate levels were significantly higher in the bacterial meningitis group (1.16 ‎‎±1.24, 7.5 ± 6.6, respectively) than patients with aseptic meningitis (0.059 ± 0.04, 3.98 ± 2.1, respectively). ‎The measuring of both serum procalcitonin and CSF lactate levels had got a higher sensitivity, specificity, and ‎accuracy (96.6%, 76.9%, 90.9% respectively) for the diagnosis of bacterial meningitis more than measuring ‎either of them only‎‎‎. Conclusion: The combined measuring of both serum procalcitonin and CSF lactate levels is highly accurate in the diagnosis ‎of bacterial meningitis cases and helps to differentiate bacterial meningitis from aseptic meningitis‎‎‎‎.

IMPACT OF MOLECULAR METHOD FOR THE DIAGNOSIS OF ACUTE BACTERIAL MENINGITIS IN A TERTIARY HEALTH CARE CENTRE IN NORTH INDIA

Background. Acute bacterial meningitis is one of the significant infectious diseases that add an immense burden to the health system. Proper management of meningitis is an invincible need to overcome the severe consequences. Objectives. The aim of the study is detection of the etiological agents of acute bacterial meningitis by PCR. Methods. Total 267 CSF samples collected from suspected bacterial meningitis cases were processed for the detection of S. pneumoniae, H. influenzae, N. meningitidis, E. coli and Group B streptococci by conventional and molecular diagnosis method. CSF was inoculated on Blood, chocolate and MacConkey agar plates and incubated at 37 °C for 24-48 hrs. Bacteria grown were identified by Matrix assisted laser desorption/ionization time of flight (MALDI-TOF). Multiplex PCR of the enlisted bacteria was performed using DNA extracted from CSF by DNA extraction kit (Qiagen, USA). Results. 5 (1.87%) out of the total 267 CSF samples were culture positive (3 S. pneumoniae and 2 E. coli) and 28 (10.49%) had detectable DNA by conventional PCR. Out of these 28 samples, 20 (71.43%) were S. pneumoniae and 8 (28.57%) were E. coli. 15 (53.57%) out of total S. pneumoniae were present in children below 5 years of age. Similarly, E. coli was predominant in neonates. Sensitivity and specificity of the PCR was 100% and 95-98% respectively. Conclusions. Streptococcus pneumoniae is the commonest cause of community acquired bacterial meningitis in children below five years of age. Hence, for the promising outcome, PCR should be implemented for the diagnosis of acute bacterial meningitis.

COVID-19 and lessons learned from the pandemic wave of meningococcal meningitis (1985-1990).

A novel coronavirus was first identified in late 2019 to cause an outbreak of acute respiratory illness in Wuhan city in China. The disease was designated COVID-19 (coronavirus disease 2019) by the World Health Organization (WHO) in February 2020. Worldwide, the infection spread affecting more than 3 million confirmed cases, mainly in Europe and USA, and was characterised by the WHO as a pandemic in March 2020. During 1985-1990, a similar pandemic wave of meningococcal (MC) meningitis spread over vast territories in Asia (including Saudi Arabia) and Africa (including Sudan and Ethiopia with more than 70,000 cases). The Sudanese Journal of Paediatrics (SJP) is taking the opportunity to document the history of this pandemic in Sudan, which has been successfully managed within Sudan/Sweden scientific link program involving the University of Khartoum, Sudan and Uppsala University, Sweden. This joint research project evaluated a rapid antigen test for the diagnosis of acute bacterial meningitis which later proved to be adaptable to the field situation during the 1988 MC epidemic. It also constituted one of the pioneering works in molecular epidemiology and proved to be vital in controlling epidemic meningitis worldwide. Based on this and other bacteriologic and epidemiologic data, a new conjugate vaccine was later developed which put an end to Group A meningococcal epidemics. Lessons learnt from this pandemic, which also applied in case of coronavirus disease 2019 (COVID-19), are also highlighted.

Factors associated with early complications in inpatients who were treated in our clinic between 1992 and 2011 with a diagnosis of acute bacterial meningitis.

Aim:To evaluate factors associated with the development of early complications in acute bacterial meningitis.Material and Methods:In our study, 389 patients diagnosed with acute bacterial meningitis between January 1992 and January 2011 at Cerrahpaşa Medical Faculty were retrospectively analyzed to determine the risk factors for the development of early complications.Results:The causative agent was N. meningitidis in 17% of cases, S. pneumoniae in 13.6%, and H. influenzae type b in 6.4%. In 55.5% of cases, the causative agent could not be identified. The mortality rate was found as 1% and the early complication rate was 27.8%. The complications observed included septic shock and disseminated intravascular coagulation (33.3%), hydrocephalus (23.1%), subdural effusion (19.4%), and epilepsy (12%). Risk factors for early complications included being aged below two years (p<0.010), restlessness (p<0.010), rash (p<0.010), leukocytosis in complete blood count (p<0.010), and a cerebrospinal fluid glucose level of <45 mg/dL (p<0.010). Three of the four patients who died were male. The incidence of hydrocephalus was higher in patients who used ampicillin-cefotaxime and who did not receive steroid therapy before treatment (p<0.050).Conclusion:When acute bacterial meningitis is treated properly and adequately, recovery without sequela is possible. Knowing the risk factors for early complications will guide in the monitoring of patients and decrease morbidity and mortality rates.

A child with Gradenigo syndrome presenting with meningism: a case report

BackgroundThe symptoms of meningitis which include fever, headache, photophobia and irritability along with abducens nerve palsy pose a diagnostic dilemma requiring urgent attention. Here we report how such a dilemma was methodically and sequentially resolved using anatomical knowledge supported by neuroimaging and the eventual diagnosis of Gradenigo syndrome was made.Case presentationA 6-year-old previously healthy boy from Sri Lanka presented with high grade fever, headache, photophobia and left eye pain for 10 days and diplopia for 2 days duration. Neurological examination was unremarkable except for left sided abducens nerve palsy. He had high inflammatory markers and white blood cell count. A tentative differential diagnosis of acute bacterial meningitis complicated by cerebral oedema, acute hydrocephalus or cerebral abscess was made. However, non-contrast CT brain, cerebrospinal fluid analysis and electroencephalogram were normal leading to a diagnostic dilemma. MRI brain with contrast performed 3 days later due to limited resources revealed left mastoiditis extending to petrous temporal bone confirming Gradenigo syndrome.ConclusionThis case report highlights the importance of a thorough physical examination in children presenting with unrelated neurological symptoms and signs. Unilateral abducens nerve palsy raises the suspicion of increased intracranial pressure and neuroimaging is vital in diagnostic uncertainties. Gradenigo syndrome emphasises the importance of incorporating anatomical knowledge into clinical practice.

Validation of multiplex PCR for the diagnosis of acute bacterial meningitis in culture negative cerebrospinal fluid.

This study evaluated the operational characteristics of the multiplex polymerase chain reaction (PCR) for cerebrospinal fluid (CSF) from patients with cellular and biochemical characteristics of acute bacterial meningitis and positive or negative CSF cultures. Multiplex PCR was performed for 36 CSF samples: culture-proven acute bacterial meningitis (n = 7), culture-negative acute bacterial meningitis (n = 17), lymphocytic meningitis (n = 8), and normal CSF (n = 4). The operational characteristics of multiplex PCR were evaluated with definite and probable bacterial meningitis, using culture positive, cytological and biochemical CSF characteristics as the gold standard. Multiplex PCR for CSF was efficient in the group with CSF cellular and biochemical characteristics of acute bacterial meningitis but with a negative CSF culture. This group demonstrated high specificity, positive predictive value, and efficiency. Multiplex PCR for CSF can improve the speed and accuracy of acute bacterial meningitis diagnosis in a clinical setting as a complement to classical immunological and bacteriological assays in CSF. It is also useful for CSF culture-negative acute bacterial meningitis.

Impact of the real time PCR in the diagnosis of acute bacterial meningitis in infants in a tertiary health care center in India

Impact of the real time PCR in the diagnosis of acute bacterial meningitis in infants in a tertiary health care center in India

345. Diagnosis of Acute Bacterial Meningitis by Polymerase Chain Reaction Vis-a-vis Conventional Culture Method

BackgroundBacterial Meningitis is one of the leading causes of mortality and morbidity worldwide requiring immediate diagnosis followed by medical intervention to prevent sequeale. Molecular methods can help to detect the pathogens offering a prompt and accurate diagnosis.MethodsOne hundred CSF and blood samples were collected from suspected/clinically diagnosed cases of meningitis over a period of 1year. CSF samples were processed by conventional and molecular methods. The objectives of the study were to identify the common bacterial etiological agent, to assess the utility of PCR in diagnosis of acute bacterial meningitis, and to know the antimicrobial susceptibility pattern.ResultsOut of 100 samples, maximum cases presented with frank meningeal signs (45%) followed by clinically suspected cases (42%). Microscopic examination, CSF culture, PCR detected 7%, 24%, and 40% positive cases, respectively. Thirteen percent were detected positive by blood culture. The positivity on CSF culture was comparable to the study done by Mani et al. (40.5%). The predominant pathogens isolated were K. pneumoniae (37.5%) followed by Streptococcus pneumoniae and Acinetobacter spp. (each 16.67%). PCR positive followed by Gene sequencing revealed Pseudomonas aeruginosa (34.78%) as the predominant pathogen. Culture is considered as the gold standard. However, it fails to identify fastidious organisms and often gives false-negative results. Therefore, the gold standard was modified to consider parameters like-clinical signs of meningitis, CSF biochemistry indicative of meningitis and CSF positive on any one microbiological test (CSF staining/CSF culture/blood culture). The performance of PCR was then improved to sensitivity (67.74%); specificity (72.46%); diagnostic accuracy (71%); PPV 52.50% and NPV 83.34%. The kappa coefficient −0.372 showed a fair agreement, considering the modified gold standard. This criterian was also used in study done by Welinder-Olsson et al.ConclusionGram-negative enteric bacteria were the most common etiology reported by both the methods. PCR could detect more cases than conventional culture method indicating its utility in the diagnosis of acute meningitis. Apart from microbiological parameters, clinical and other laboratory parameters should be considered to achieve a precise diagnosis.Disclosures All authors: No reported disclosures.

Development and Assessment of a Diagnostic DNA Oligonucleotide Microarray for Detection and Typing of Meningitis-Associated Bacterial Species

Meningitis is commonly caused by infection with a variety of bacterial or viral pathogens. Acute bacterial meningitis (ABM) can cause severe disease, which can progress rapidly to a critical life-threatening condition. Rapid diagnosis of ABM is critical, as this is most commonly associated with severe sequelae with associated high mortality and morbidity rates compared to viral meningitis, which is less severe and self-limiting. We have designed a microarray for detection and diagnosis of ABM. This has been validated using randomly amplified DNA targets (RADT), comparing buffers with or without formamide, in glass slide format or on the Alere ArrayTubeTM (Alere Technologies GmbH) microarray platform. Pathogen-specific signals were observed using purified bacterial nucleic acids and to a lesser extent using patient cerebral spinal fluid (CSF) samples, with some technical issues observed using RADT and glass slides. Repurposing the array onto the Alere ArrayTubeTM platform and using a targeted amplification system increased specific and reduced nonspecific hybridization signals using both pathogen nucleic and patient CSF DNA targets, better revealing pathogen-specific signals although sensitivity was still reduced in the latter. This diagnostic microarray is useful as a laboratory diagnostic tool for species and strain designation for ABM, rather than for primary diagnosis.