Evaluation of a Multiplex Real-time PCR and WHO Criteria for Diagnosis of Childhood Bacterial Meningitis at a Tertiary Referral Hospital in Iran

Background:Bacterial meningitis (BM),caused commonly by Streptococcus Pneumonia and Neisseria meningitidis and Haemophilus influenza type b(HiB),is one of the most severe infectious diseases of children with high mortality and morbidity. Rapid and accurate diagnosis of BM is crucial to start treatment aiming to reduce its mortality complications and sequel.Objectives:We aimed to determine the sensitivity and specificity of WHO criteria for diagnosis of BM and a multiplex real-time polymerase chain reaction (PCR) in children at a tertiary referral hospital in Shiraz, southern Iran.Methods: All children aged 1month to17years who were clinically suspected to meningitis and had pleocytosis ( more than 5 white blood cells/microliter in CSF) and admitted to Nemazee Teaching Hospital, Shiraz, between Augusts 2016and September2017 were included. CSF specimens were examined for cell count and differential cell count, sugar, protein, Gram stain, culture, and the identification of pneumococci, HiB, and meningococciusinga multiplex real-time PCR .Bacterial meningitis refers to patients who have clinical and laboratory evidence for meningeal inflammation with positive Gram stain, routine bacterial cultures, or bacterial PCR test result.Results: Among 74 patients with pleocytossis, 17 patients (22.9%) had bacterial meningitis based on PCR result: 14with pneumococci, two HiB, and one meningococcci. 16 patients (21.6%) were diagnosed with bacterial meningitis according to WHO criteria, of which 14 had positive PCR. the consistency of the WHO criteria with the positive PCR results of the cerebrospinal fluid, the sensitivity and specificity of the WHO criteria for diagnosis of bacterial meningitis are 82.35% and 95%, respectively.Conclusions: Delay in performing LP after starting antibiotic and uncommon etiology of BM in children is the major limitations of the WHO criteria and the PCR test, respectably.

Keywords:

Meningitis , World Health Organization Standards , Diagnosis , Polymerase Chain Reaction , Iran