Arch Dis Child 2000;83:271-273 ( September )

Methodology

Performance characteristics of the polymerase chain reaction assay to confirm clinical meningococcal disease E D Carrol^a, A P J Thomson^a, P Shears^b, S J Gray^c, E B Kaczmarski^c, C A Hart^b

^a Institute of Child Health, Royal Liverpool Children's Hospital, Alder Hey, Eaton Road, Liverpool L12 2AP, UK, ^b Department of Medical Microbiology, University of Liverpool, Duncan Building, Daulby Street, Liverpool L69 3GA, UK, ^c Meningococcal Reference Unit, Manchester Public Health Laboratory, Withington Hospital, Nell Lane, Manchester M20 2LR, UK

Correspondence to: Dr Carrol email: edcarrol{at}liverpool.ac.uk

Accepted 4 May 2000

BACKGROUNDConfirmation of clinical meningococcal disease (MCD) is essential for management of patients, contacts, and outbreaks. Blood and CSF cultures, the traditional gold standard diagnostic tests, have been adversely affected by preadmission parenteral penicillin and fewer lumbar punctures. Rapid, reliable serogroup determination without the need to grow isolates could improve laboratory confirmation of MCD.
AIMSTo determine performance characteristics of the currently available meningococcal polymerase chain reaction (PCR) assays in a clinical setting.
METHODSProspective study of 319 children presenting with a suspected diagnosis of MCD (fever and a rash, or suspected bacterial meningitis) over a 16 month period.
RESULTSA total of 166 (52% of all) children had clinical MCD: diagnosis was confirmed microbiologically in 119 (72%) of these. Performance characteristics (sensitivity, specificity, negative predictive value, positive predictive value) in confirmation of clinical MCD were respectively (95% confidence interval): blood culture 31% (24-38%), 100%, 57% (49-65%), 100%; blood PCR 47% (39-55%), 100%, 65% (58-73%), 100%; any test positive 72% (65-79%), 100%, 77% (70-84%), 100%.
CONCLUSIONSMeningococcal DNA detection in blood or CSF by PCR is a useful method of diagnosis of MCD. PCR of peripheral blood performs better than blood culture. In a child with clinically suspected MCD, PCR assays, bacterial antigen tests, and oropharyngeal swabbing for meningococcal carriage should be performed in addition to blood or CSF culture, to improve case confirmation.


Keywords: polymerase chain reaction assay; meningococcal disease; confirmation; performance characteristics

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© 2000 by Archives of Disease in Childhood
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