Identification of bacterial aetiology in acute meningitis.

Background: The lack of rapid and sensitive test remains a key issue in diagnosing meningitis and affordability impedes using the molecular techniques. However, conventional PCR is currently becoming more affordable. Objectives: Optimize and establish a multiplex PCR and to compare the above PCR to Cerebrospinal fluid (CSF) culture and antigen detection in sensitivity and specificity for the detection of bacterial meningitis. Methods: CSF specimens were collected from patients with suspected acute meningitis admitted to Teaching Hospital, Peradeniya from December 2016 to March 2017. A multiplex PCR was used to detect Neisseria meningitides, Streptococcus pneumonia and Haemophilus influenzae. Results: Eighty specimens of CSF were collected during the study period. The mean duration to sample collection was 4.78(SD 2.6) from the onset of symptoms. None of the samples given positive CSF culture. CSF antigen detection was performed on 50 specimens and all were negative. Of the total samples, eight yielded positive PCR results. In two of the positives, the full report was normal, one was suggestive of viral aetiology and five were suggestive of bacterial aetiology. Three were positive for S.pneumoniae and five for H.influenzae. positive PCR results were associated with a shorter time gap between hospitalization and sample collection and a larger CSF volume. Conclusion: Findings of the study highlight the usefulness and recommendation of multiplex PCR in the diagnosis of pathogens causing acute bacterial meningitis. Collection of an adequate volume of CSF early in the illness, without delay may improve the diagnosis.

Spondylodiscitis Caused by Enterobacter agglomerans.

All over the globe, the incidence of vertebral infection is rising. Nowadays, compared to tuberculous variety, pyogenic spondylodiscitis incidence is high. The increase in the susceptible population and improved diagnostics summatively contributed to this. In clinical grounds, differentiation of pyogenic and tuberculous spondylodiscitis is well defined. Enterobacter agglomerans is a hospital contaminant and associated with infections in immunocompromised individuals and intravenous lines. It causes a wide array of infections. Enterobacter agglomerans spondylodiscitis is unusual and there are, around the globe, only less than 31 suspected cases that have been previously reported. Enterobacter agglomerans histology mimics tuberculous rather than pyogenic spondylodiscitis. A 65-year-old farming lady, while being in hospital, developed sudden onset spastic paraparesis with hyperreflexia. Later blood culture revealed Enterobacter agglomerans with 41-hour incubation in 99.9% probability from Ramel identification system. Her initial ESR was 120 mm/first hour. Isolate was susceptible to ciprofloxacin and intravenous followed with oral therapy shows a drastic ESR fall and improved clinical response. Differentiation of tuberculous and pyogenic spondylodiscitis is very much important in management point of view. Therefore, blood culture has a role in diagnosis of spondylodiscitis. ESR can be used as important inflammatory marker in monitoring the response to treatment. Retrospectively, ESR would aid in reaching a definitive diagnosis.