Last modified: 2018-09-09
Abstract
Introduction: Acute bacterial Meningitis(ABM) is a life threatening infection of central nervous system with fatality rates from 2% to 20-30% in neonates. The yield of positive cerebrospinal fluid (CSF) cultures is low. PCR provides a valuable supplement to routine microscopy and culture of CSF in diagnosis of ABM.
Objectives: The present study was done with the objective to find out the utility of molecular detection of organism in CSF and identify different organisms by molecular methods through amplification of bacterial genomic 16SrDNA gene by PCR.
Methods: Eighty four children aged 5 days - 15 years were taken in this study with suggestive clinical manifestations of ABM. All samples of CSF and blood were analyzed for white blood cell (WBC) count, measurement of glucose, protein, and conventional bacteriologic culture methods as well as 16SrDNA PCR in CSF.
Results: Of the 84 patients, 16SrDNA PCR of CSF was positive in 72 (85.7%) cases. Multiplex PCR for Neisseria meningitides (nsp gene), Hemophilus infuenzae-b (bex DCBA gene) & Streptococcus pneumoniae (pneumolysin gene) was positive for 3 (3.5%), 1 (1.2%) & 7 (8.3%) cases respectively. Sensitivity, Specificity, Negative Predictive Value (NPV), Positive Predictive Value (PPV) and Accuracy of 16SrDNA PCR was observed to be 100%, 15.58%, 9.72%, 100% and 22.62% respectively. On comparing laboratory parameters between survivors and non survivors, significant association was found between CSF protein levels (p=0.008) only.
Conclusion:The use of 16SrDNA targeting universal eubacterial nested PCR improves organism detection rate from CSF meningitis, even if previously treated with antibiotics