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Meningococcal bacterial DNA load at presentation correlates with disease severity
S J Hackett1, M Guiver, J Marsh
1Institute of Child Health, Alder Hey Children's Hospital, Eaton Road, Liverpool L12 2AP, UK. scott.hackett@liv.ac.uk
Aims:
To determine bacterial loads in meningococcal disease (MCD), their relation with disease severity, and the factors which determine bacterial load.
Methods:
Meningococcal DNA quantification was performed by the Taqman PCR method on admission and sequential blood samples from patients with MCD. Disease severity was assessed using the Glasgow Septicaemia Prognostic Score (GMSPS, range 0-15, severe disease > or =8).
Results:
Median admission bacterial load was 1.6 x 10(6) DNA copies/ml of blood (range 2.2 x 10(4) to 1.6 x 10(8)). Bacterial load was significantly higher in patients with severe (8.4 x 10(6)) compared to milder disease (1.1 x 10(6), p = 0.018). This difference was greater in septicaemic patients (median 1.6 x 10(7) versus 9.2 x 10(5), p < 0.001). Bacterial loads were significantly higher in patients that died (p = 0.017). Admission bacterial load was independent of the duration of clinical symptoms prior to admission, with no difference between the duration of symptoms in mild or severe cases (median, 10.5 and 11 hours respectively). Bacterial loads were independent of DNA elimination rates following treatment.
Conclusion:
Patients with MCD have higher bacterial loads than previously determined with quantitative culture methods. Admission bacterial load is significantly higher in patients with severe disease (GMSPS > or =8) and maximum load is highest in those who die. Bacterial load is independent of the duration of clinical symptoms or the decline in DNA load.
Insights
Higher bacterial loads in meningococcal disease (MCD) correlate with increased severity and mortality. Admission bacterial load, a key indicator, is independent of symptom duration or treatment response.
Area of Science:
- Microbiology
- Infectious Diseases
- Clinical Diagnostics
Background:
- Meningococcal disease (MCD) is a severe infection with variable outcomes.
- Accurate quantification of bacterial load is crucial for understanding disease pathogenesis and severity.
- Previous methods may have underestimated bacterial loads in MCD.
Purpose of the Study:
- To quantify bacterial loads in patients with meningococcal disease (MCD).
- To investigate the relationship between bacterial load and disease severity.
- To identify factors influencing bacterial load in MCD.
Main Methods:
- Meningococcal DNA was quantified using the Taqman PCR method on blood samples.
- Disease severity was assessed using the Glasgow Septicaemia Prognostic Score (GMSPS).
- Bacterial loads and DNA elimination rates were analyzed in relation to clinical data.
Main Results:
- Median admission bacterial load was 1.6 x 10^6 DNA copies/ml.
- Significantly higher bacterial loads were observed in severe MCD (GMSPS ≥ 8) and fatal cases.
- Bacterial load was independent of symptom duration prior to admission and DNA elimination rates post-treatment.
Conclusions:
- Quantitative PCR reveals higher bacterial loads in MCD than previously reported.
- Admission bacterial load is a significant predictor of disease severity and mortality in MCD.
- Bacterial load dynamics are not influenced by symptom duration or initial treatment response.