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Underestimation of Invasive Meningococcal Disease in Italy

Chiara Azzari, Francesco Nieddu, Maria Moriondo

    Emerging Infectious Diseases
    |February 19, 2016
    PubMed

    Insights

    Invasive meningococcal disease (IMD) is often underestimated due to misdiagnosis and limited lab sensitivity. Real-time PCR (rPCR) significantly improves IMD case detection, especially in postmortem samples.

    Area of Science:

    • Microbiology
    • Epidemiology
    • Vaccinology

    Background:

    • Accurate incidence data for invasive meningococcal disease (IMD) is crucial for effective vaccination policy development.
    • Current diagnostic methods, primarily culture-based, may underestimate IMD prevalence due to limitations in sensitivity and potential for misdiagnosis.

    Observation:

    • A national molecular surveillance register utilizing real-time PCR (rPCR) was employed to re-evaluate IMD cases.
    • The study assessed misdiagnosed cases, postmortem diagnoses, and compared the sensitivity of rPCR against traditional culture methods.

    Findings:

    • Out of 26 fatal cases, 11 (42%) were initially misdiagnosed or undiagnosed, with rPCR confirming meningococcal DNA in postmortem specimens.
    • Real-time PCR alone diagnosed 58% of samples that were negative by culture-based methods.
    • Culture-based testing alone resulted in an underestimation factor of 3.28 for IMD incidence.

    Implications:

    • The widespread underestimation of IMD incidence in regions with limited rPCR use, such as Italy, can lead to inaccurate assessments of meningococcal vaccine efficacy and public health impact.
    • Implementing molecular diagnostic tools like rPCR is essential for precise IMD surveillance and informed public health strategies.
    Keywords:
    ItalyNeisseria meningitidisPCRbacteriabacterial meningitisinvasive meningococcal diseasemisdiagnosisunderestimationunderreporting

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