Cerebrospinal Fluid (CSF) Polymerase Chain (PCR) Reaction Improves Diagnostic Sensitivity for Bacterial Meningitis IN ASIAN CHILDREN

Kennedy WA¹, Chang SJ¹, Purdy K¹, Kim JS², Anh DD³, Kilgore P⁴, Clemens JD⁴ and Ward JI¹

¹UCLA Center for Vaccine Research, Torrance, California, U.S.A.; ²Chonbuk National University Hospital, Chonju, S. Korea, ³National Institute of Hygiene and Epidemiology, Hanoi, Vietnam; ⁴International Vaccine Institute, Seoul, S. Korea

Objectives: To evaluate CSF PCR and latex agglutination antigen (LA) testing to detect H. influenzae type b (Hib), S. pneumoniae (Sp) meningitis cases compared with CSF culture.

Methods: During 1999 - 2000, CSF specimens were taken from infants and children < 5 years of age with suspected meningitis; Korea (n=611) and Vietnam (n=218). 261 abnormal CSF and 30 normal CSF specimens were tested by LA. A subset of these CSFs were tested by PCR to detect Hib meningitis using primers directed against the bexA gene and confirmed with a colorimetric probe ELISA assay (n=152). Also, CSF PCR for Sp was performed using lytA gene primers and confirmed by gel band visualization (n =114).

Results:

Test	Positive Hib Culture	Negative Hib Culture	Positive Sp Culture	Negative Sp Culture
LA +	23	0	5	0
LA -	4	121	0	142
PCR +	27	2	6	1
PCR -	1	122	0	107

CSF latex agglutination antigen testing for Sp was equivalent to culture but for Hib, less sensitive than culture. PCR of the CSF for Hib detected 2 more than the 28 cases detected by culture. PCR of the CSF for SP detected 1 more than the 6 cases detected by culture.

Conclusions: CSF LA testing was either equivalent (Sp) or less sensitive (Hib) than culture for meningitis case detection. CSF PCR testing for both Hib and Sp showed improved sensitivity of case detection of bacterial meningitis in infants and children in Asia compared with culture alone. CSF PCR testing in conjunction with culture, needs to be further studied as an optimal means of meningitis case detection.in vaccine efficacy trials.

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