Use	of the PCR technique to diagnose meningitis	in children admitted to Red Cross War Memorial Children’s Hospital

Mteshana, Phindile

Use of the PCR technique to diagnose meningitis in children admitted to Red Cross War Memorial Children’s Hospital

Master Thesis

2019

Abstract

Introduction: Viral meningitis (VM) is more common than bacterial meningitis (BM) and is a self-limiting disease. Clinicians still tend to admit patients with VM and treat them for BM because they fear the morbidity and mortality that is associated with a delay in treating or not treating BM. Unnecessary admissions have huge cost implications and they separate children from their parents while exposing them to painful procedures and unnecessary antibiotics. Methods: A structured literature review was undertaken to see whether clinical manifestation and examination findings and laboratory findings including viral PCR of cerebrospinal fluid can help to diagnose viral meningitis and avoid unnecessary admissions. Results: Viral and bacterial meningitis have similar clinical findings. CSF examination is crucial in confirming the diagnosis of meningitis. Microscopy and culture remain the gold standard in making the diagnosis. The introduction of the Haemophilus influenzae type b and pneumococcal vaccines into the South African Expanded Programme on immunization (EPI) markedly reduced the incidence of invasive Haemophilus influenzae type b and pneumococcal disease in children under 5 years-of-age as in other countries where they are used. Viral meningitis is the leading cause of childhood meningitis however the clinical and CSF findings in viral meningitis and bacterial meningitis overlap. The sensitivity of CSF culture has been shown to be around 81.3%, but is very much affected by prior antibiotics. Traumatic/bloody CSF taps also make it difficult to interpret 10 results. Inflammatory markers have been used in conjunction with CSF results in differentiating between BM and VM however, the use of polymerase chain reaction technique in the diagnostic methodology improves the sensitivity to more than 95%. Conclusion: Viral meningitis is common worldwide. Real-time multiplex PCR offers value in accurately detecting common viral and bacterial pathogens thus allowing for appropriate patient management. In order to avoid the risk of not identifying organisms not included in the PCR assay and further not being able to do susceptibility testing on those organisms, it important to realize that PCR testing would have to be done in addition to culture, and not as a replacement.

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