The Role of Molecular Testing in Pediatric Meningitis Surveillance in Southern and East African Countries, 2008-2017.

Abstract

BACKGROUND:

As part of the global Invasive Bacterial Vaccine-Preventable Diseases Surveillance Network, 12 African countries referred cerebrospinal fluid (CSF) samples to South Africa's regional reference laboratory. We evaluated the utility of real-time polymerase chain reaction (PCR) in detecting and serotyping/grouping Haemophilus influenzae, Neisseria meningitidis, and Streptococcus pneumoniae (HNS).

METHODS:

From 2008 to 2017, CSF samples collected from children <5 years old with suspected meningitis underwent routine microbiology testing in-country, and 11 680 samples were submitted for HNS PCR at the regional reference laboratory. Unconditional logistic regression, with adjustment for geographic location, was performed to identify factors associated with PCR positivity.

RESULTS:

The overall HNS PCR positivity rate for all countries was 10% (1195 of 11 626 samples). In samples with both PCR and culture results, HNS PCR positivity was 11% (744 of 6747 samples), and HNS culture positivity was 3% (207 of 6747). Molecular serotype/serogroup was assigned in 75% of PCR-positive specimens (762 of 1016). Compared with PCR-negative CSF samples, PCR-positive samples were more often turbid (adjusted odds ratio, 6.80; 95% confidence interval, 5.67-8.17) and xanthochromic (1.72; 1.29-2.28), had elevated white blood cell counts (6.13; 4.71-7.99) and high protein concentrations (5.80; 4.34-7.75), and were more often HNS culture positive (32.70; 23.18-46.12).

CONCLUSION:

PCR increased detection of vaccine-preventable bacterial meningitis in countries where confirmation of suspected meningitis cases is impeded by limited culture capacity.

• Authors: Mignon du Plessis, Linda de Gouveia, Cesar Freitas, Negga Asamene Abera, Budiaki Sylvie Lula, Julia Liliane Raboba, Aquino Albino Nhantumbo, Elana Jantjies, Jeannine Uwimana, Nomcebo Phungwayo, Gugu Maphalala, Gilbert Masona, John Muyombe, David Mugisha, Esther Nalumansi, Moses Odongkara, Chileshe Lukwesa-Musyani, Ruth Nakazwe, Vongai Dondo, John Macharaga, Goitom G Weldegebriel, Jason M Mwenda, Fatima Serhan, Adam L Cohen, Fernanda C Lessa, Anne von Gottberg
• Journal: The Journal of infectious diseases (J Infect Dis) Vol. 224 Issue 12 Suppl 2 Pg. S194-S203 (09 01 2021) ISSN: 1537-6613 [Electronic] United States
• PMID: 34469556 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America.

Chemical References

• Bacterial Vaccines

Topics

• Africa, Eastern (epidemiology)
• Africa, Southern (epidemiology)
• Bacterial Vaccines (therapeutic use)
• Child, Preschool
• Female
• Haemophilus influenzae (genetics, isolation & purification)
• Humans
• Infant
• Infant, Newborn
• Male
• Meningitis, Bacterial (diagnosis, epidemiology, genetics)
• Molecular Diagnostic Techniques
• Neisseria meningitidis (genetics, isolation & purification)
• Public Health Surveillance
• Real-Time Polymerase Chain Reaction (methods)
• Streptococcus pneumoniae (genetics, isolation & purification)