Utility of the urine reagent strip leucocyte esterase assay for the diagnosis of meningitis in resource-limited settings: meta-analysis
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
Tropical Medicine & International Health
Abstract
Diagnosis of bacterial meningitis often requires cytometry, chemistry and/or
microbiologic culture capabilities. Unfortunately, laboratory resources in low-resource settings (LRS)
often lack the capacity to perform these studies. We sought to determine whether the presence of
white blood cells in CSF detected by commercially available urine reagent strips could aid in the
diagnosis of bacterial meningitis.
methods We searched PubMed for studies published between 1980 and 2016 that investigated the
use of urine reagent strips to identify cerebrospinal fluid (CSF) pleocytosis. We assessed studies in any
language that enrolled subjects who underwent lumbar puncture and had cerebrospinal fluid testing
by both standard laboratory assays and urine reagent strips. We abstracted true-positive, falsenegative,
false-positive and true-negative counts for each study using a diagnostic threshold of ≥10
white blood cells per microlitre for suspected bacterial meningitis and performed mixed regression
modelling with random effects to estimate pooled diagnostic accuracy across studies.
results Our search returned 13 studies including 2235 participants. Urine reagent strips detected
CSF pleocytosis with a pooled sensitivity of 92% (95% CI: 84–96), a pooled specificity of 98% (95%
CI: 94–99) and a negative predictive value of 99% when the bacterial meningitis prevalence is 10%.
conclusions Urine reagent strips could provide a rapid and accurate tool to detect CSF pleocytosis,
which, if negative, can be used to exclude diagnosis of bacterial meningitis in settings without
laboratory infrastructure. Further investigation of the diagnostic value of using protein, glucose and
bacteria components of these strips is warranted.
Description
Keywords
Urine reagent strip, Meningitis, Cerebrospinal fluid, Reagent strip, Urine test strip
Citation
Bortcosh, W., Siedner, M., & Carroll, R. W. (2017). Utility of the urine reagent strip leucocyte esterase assay for the diagnosis of meningitis in resource‐limited settings: meta‐analysis. Tropical Medicine & International Health, 22(9), 1072-1080. doi:10.1111/tmi.12913