Polymerase Chain Reaction Testing in Comparison to Culture of Cerebrospinal Fluid for Diagnosis of Bacterial Meningitis in Children

Abstract

background: Childhood bacterial meningitis is a neurological exigency. Accurate, early, rapid diagnosis and treatment is essential to decrease its morbidity and mortality. Aim of study: This is a retrospective study comparing real-time polymerase chain reaction (RT-PCR), with standard bacterial culture for the diagnosis of bacterial meningitis during cerebrospinal fluid (CSF) examination.Materials and methods: RT-PCR was used for the detection of three most common causes of bacterial meningitis (Streptococcus pneumonia, Haemophilus influenza type b, and Neisseria meningitides) in 100 CSF samples from children aged 2 months to 12 years admitted to Al-Elwiya Pediatric Teaching Hospital during the period from January 2016 to January 2017 Results: Growth was detected in 6% CSF cultures of patients included in the study and Streptococcus pneumoniae was the most prominent isolated bacteria. RT-PCR was positive in 43% CSF samples from which S. pneumoniae was identified in all samples. PCR and culture showed concordance in 6% positive and 57% negative samples. Using culture as a reference method, the sensitivity, specificity, and positive and negative predictive values for PCR on CSF samples were 100 %, 60.64%, 13.93% and 100 %, respectively. RT-PCR was positive in 37% CSF samples whereas culture was negative.Conclusion: RT-PCR is a rapid and sensitive test for the diagnosis of bacterial meningitis. The findings of this retrospective study recommend the use of RT-PCR for the diagnosis of children with a clinical suspicion of bacterial meningitis and as a complement to culture, especially, those who received previous antibiotic treatment before lumbar puncture.