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Incorporation of real-time PCR into routine public health surveillance of culture negative bacterial meningitis in São Paulo, Brazil.

Sacchi, Claudio T; Fukasawa, Lucila O; Gonçalves, Maria G; Salgado, Maristela M; Shutt, Kathleen A; Carvalhanas, Telma R; Ribeiro, Ana F; Kemp, Brigina; Gorla, Maria C O; Albernaz, Ricardo K; Marques, Eneida G L; Cruciano, Angela; Waldman, Eliseu A; Brandileone, M Cristina C; Harrison, Lee H.
PLoS One; 6(6): e20675, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21731621
Real-time (RT)-PCR increases diagnostic yield for bacterial meningitis and is ideal for incorporation into routine surveillance in a developing country. We validated a multiplex RT-PCR assay for Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae in Brazil. Risk factors for being culture-negative, RT-PCR positive were determined. The sensitivity of RT-PCR in cerebrospinal fluid (CSF) was 100% (95% confidence limits, 96.0%-100%) for N. meningitidis, 97.8% (85.5%-99.9%) for S. pneumoniae, and 66.7% (9.4%-99.2%) for H. influenzae. Specificity ranged from 98.9% to 100%. Addition of RT-PCR to routine microbiologic methods increased the yield for detection of S. pneumoniae, N. meningitidis, and H. influenzae cases by 52%, 85%, and 20%, respectively. The main risk factor for being culture negative and RT-PCR positive was presence of antibiotic in CSF (odds ratio 12.2, 95% CI 5.9-25.0). RT-PCR using CSF was highly sensitive and specific and substantially added to measures of meningitis disease burden when incorporated into routine public health surveillance in Brazil.