Tools for Meningitis Diagnostics Implemented in Resource-Limited Settings

Meningitis remains a top cause of premature death and loss of disability-adjusted life years in low-income countries. In resource-limited settings, proper laboratory diagnostics are often scarce and knowledge about national and local epidemiology is limited.

Misdiagnosis, incorrect treatment and overuse of antibiotics are potential consequences, especially for viral meningitis. Early treatment is essential in the clinical management of meningitis. A delay in therapy negatively affects the prognosis for patients with both bacterial and viral meningitis/encephalitis.

Scientists from the University of Oslo (Oslo, Norway) and their Ethiopian colleagues conducted a prospective study over three months in a teaching hospital in Ethiopia. Cerebrospinal fluid (CSF) samples were collected from patients with suspected meningitis. Basic routine testing with microscopy and culture were performed and clinical data, as well as information on treatment and outcome were collected.

CSF samples were cultured onto blood agar and/or chocolate agar for 72 hours at 35 °C in a CO2-enriched incubator (candle jar). Routine bacterial identification was based on colony morphology, Gram staining and standard biochemical reactions. All CSF samples included in the study were analyzed using the meningitis/encephalitis (ME) panel on the bioMérieux FilmArray multiplex polymerase chain reaction system (PCR) system. Two hundred and eighteen patients were included; 117 (54%) neonates (0–29 days), 63 (29%) pediatrics (1 month-15 years) and 38 (17%) adults (≥16 years).

The investigators reported that of 218 CSF samples, 21 (10%) were PCR positive; 4% in neonates, 14% in pediatrics and 18% in adults. Virus was detected in 57% of the PCR positive samples, bacteria in 33% and fungi in 10%. All CSF samples that were PCR positive for a bacterial agent had a white cell count ≥75 cells/mm3 and/or turbid appearance. Only four (2%) of the CSF samples included in the study were found to be positive for microorganisms using conventional methods (microscopy and/or culture).

The authors concluded that a rapid molecular diagnostic system was successfully implemented in an Ethiopian setting without previous experience of molecular diagnostics. Viral meningitis was diagnosed for the first time in routine clinical practice in Ethiopia, and viral agents were the most commonly detected microorganisms in CSF. This study illustrates the potential of rapid diagnostic tests for reducing antibiotic usage in suspected meningitis cases. The study was published on December 20, 2018, in the journal BMC Infectious Diseases.

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