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

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Date
2021Author
Plessis, Mignon du
Gouveia, Linda de
Freitas, Cesar
Asamene Abera, Negga
Mugisha, David
Nalumansi, Esther
Odongkara, Moses
Lukwesa-Musyani, Chileshe
Lessa, Fernanda C.
Gottberg, Anne von
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Show full item recordAbstract
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 realtime
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, PCRpositive
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.
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