November 27, 2022

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PCR testing used for diagnosis of bacterial meningitis

PCR testing used for diagnosis of bacterial meningitis



 

 

PCR testing used for diagnosis of bacterial meningitis.   

 

In clinical practice, most patients who are clinically diagnosed with acute bacterial meningitis often use prescription antibiotics (common in less developed countries) before the cerebrospinal fluid is collected, which will greatly reduce the number of viable bacteria in the cerebrospinal fluid.

 

The gold standard for the diagnosis of acute bacterial meningitis is the presence of live bacteria in cerebrospinal fluid (CSF) culture.

Indirect diagnostic evidence includes neutrophils in the cerebrospinal fluid, elevated protein, and glucose. The polymerase chain reaction (PCR) detection of bacterial DNA in cerebrospinal fluid is becoming more and more popular.

This method is more sensitive than cerebrospinal fluid culture, but it also brings challenges to routine diagnosis and treatment.

 

Recently, Elsevier published an article in The Lancet Infectious Diseases, a well-known journal in the field of infectious diseases, to sort out the development and challenges of bacterial meningitis diagnosis.

 

The clinical symptoms, signs and cerebrospinal fluid changes of acute bacterial meningitis reported in the previous literature are based on the gold standard of cerebrospinal fluid culture results, and studies have found that 30-50% of culture-negative cerebrospinal fluid specimens have polymerase chain reaction (PCR) results Was positive.

 

In clinical practice, most patients who are clinically diagnosed with acute bacterial meningitis often use prescription antibiotics (common in less developed countries) before the cerebrospinal fluid is collected, which will greatly reduce the number of viable bacteria in the cerebrospinal fluid. 

Therefore, PCR detection of bacterial DNA can provide clinicians with more evidence.

However, the basic clinical data of bacterial DNA in cerebrospinal fluid are not yet complete. Many CSF PCR data come from patients with suspected acute bacterial meningitis, resulting in unreliable diagnostic specificity.

 

A number of studies have evaluated the value of PCR in the diagnosis of acute bacterial meningitis, questioned the traditional diagnostic methods that rely solely on cerebrospinal fluid culture, and discussed whether patients with acute bacterial meningitis should be accurately diagnosed.

 

At this stage, due to the widespread use of vaccines, the incidence of acute bacterial meningitis in high-income countries has decreased, resulting in a decrease in the probability of cerebrospinal fluid sampling and delays in answering these questions. In low-income and middle-income countries, especially where meningitis has a large-scale outbreak all year round, the burden of cerebrospinal fluid assessment for all patients is very heavy and unrealistic.

 

At present, further research is urgently needed to better describe the disease development process: central nervous system inflammation in the early stage (PCR or culture positive), live bacteria replication and inflammation, PCR becomes negative immediately after the bacteria are cleared, and finally normal cerebrospinal fluid is restored Routine and biochemical results. Such research will change the treatment of acute bacterial meningitis.

 

In addition, the inflammatory response of acute bacterial meningitis is mainly limited to astrocytes and other glial cells, and whether such responses can be detected in peripheral blood remains to be studied. Finding a surrogate marker for acute bacterial meningitis in the blood may be a new direction for the diagnosis of acute bacterial meningitis in the future.

 

 

 

 

 

(source:internet, reference only)


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