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Original Research
Enhanced pathogen identification among patients with clinically suspected meningitis
Submitted: 09 September 2024 | Published: 10 December 2024
About the author(s)
Malefu Moleleki, Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and, Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaPieter Nel, Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and, Division of Medical Microbiology, Tygerberg Hospital, National Health Laboratory Service, Cape Town, South Africa
Siphiwe R. Matukane, Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and, Division of Medical Microbiology, Tygerberg Hospital, National Health Laboratory Service, Cape Town, South Africa
Stephanie Cloete, Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Zayaan Abrahams, Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Nicole Wolter, Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
Andrew C. Whitelaw, Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and, Division of Medical Microbiology, Tygerberg Hospital, National Health Laboratory Service, Cape Town, South Africa
Abstract
Background: Delayed or incorrect treatment of meningitis may result in adverse patient outcomes. However, laboratory testing in resource-limited settings is often limited to conventional diagnostic methods. We explored the utility of syndromic molecular assays for diagnosis.
Objectives: We tested cerebrospinal fluid (CSF) specimens collected from patients with clinically suspected meningitis submitted to a tertiary hospital laboratory in January 2021 – May 2021. Primary microbiological analysis (culture, Gram stain and cytochemical analysis) was performed as part of routine testing.
Method: Residual CSF specimens were tested using a bacterial triplex real-time polymerase chain reaction (PCR) assay and a syndromic multi-pathogen real-time PCR assay for the detection of up to 18 bacterial and viral pathogens. Pathogen detection was compared between conventional and molecular assays.
Results: A potential pathogen was detected in 6% (12/188) and 47% (89/188) of specimens on the triplex and the multi-pathogen assay, respectively. Epstein-Barr virus (49/188; 26%), human herpes virus 7 (22/188; 12%), herpes simplex virus 1 (13/188; 7%) and Streptococcus pneumoniae (10/188; 5%) were the leading pathogens detected on the syndromic multi-pathogen PCR. Further, using the multi-pathogen PCR assay, a potential pathogen was detected in 44% (73/166) of the specimens which were negative following routine testing. Overall, combining routine testing and molecular platforms significantly improved pathogen detection (p < 0.001); a potential pathogen was identified in 51% (95/188) of the specimens tested, compared to 12% (22/188) using routine methods alone.
Conclusion: The use of molecular tests improved pathogen detection by 39% when paired with routine methods.
Contribution: Multi-pathogen molecular testing is useful for rapidly diagnosing meningitis cases.
Keywords
Sustainable Development Goal
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