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Published on: October 1, 2007
New molecular tools for meningitis diagnostics in Ethiopia - a necessary step towards improving antimicrobial
Guro K Bårnes1,2, Esayas Kebede Gudina3, Melkamu Berhane3
1Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.
Background:
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.
Methods:
A prospective study was conducted over three months in a teaching hospital in Ethiopia with limited laboratory resources. Cerebrospinal fluid (CSF) samples from patients with suspected meningitis were analysed using a multiplex PCR-based system (FilmArray, BioFire), in addition to basic routine testing with microscopy and culture. Clinical data, as well as information on treatment and outcome were collected.
Results:
Two hundred and eighteen patients were included; 117 (54%) neonates (0-29 days), 63 (29%) paediatrics (1 month-15 years) and 38 (17%) adults (≥16 years). Of 218 CSF samples, 21 (10%) were PCR positive; 4% in neonates, 14% in paediatrics 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. The majority (90%) of patients received more than one antibiotic for treatment of the meningitis episode. There was no difference in the mean number of different antibiotics received or in the cumulative number of days with antibiotic treatment between patients with a microorganism detected in CSF and those without.
Conclusions:
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. However, the cost of consumables for the molecular diagnostic system used in this study limits its use in low-income countries.
Insights
Rapid molecular diagnostics successfully identified viral meningitis in Ethiopia, the most common cause. This technology shows promise for reducing antibiotic overuse in meningitis cases, despite cost limitations in low-income settings.
Area of Science:
- Clinical microbiology
- Infectious diseases
- Molecular diagnostics
Background:
- Meningitis is a leading cause of death and disability in low-income countries.
- Limited laboratory resources and epidemiological data in these settings lead to misdiagnosis and antibiotic overuse.
- Viral meningitis is often underdiagnosed, particularly in resource-limited environments.
Purpose of the Study:
- To evaluate the implementation of a rapid molecular diagnostic system for meningitis in a resource-limited Ethiopian hospital.
- To assess the etiological spectrum of meningitis, including viral, bacterial, and fungal pathogens.
- To determine the impact of rapid diagnostics on antibiotic prescribing practices.
Main Methods:
- A prospective study was conducted over three months in an Ethiopian teaching hospital.
- Cerebrospinal fluid (CSF) samples were analyzed using multiplex PCR (FilmArray) alongside microscopy and culture.
- Clinical data, treatment, and outcomes were collected for 218 patients with suspected meningitis.
Main Results:
- 21% of CSF samples tested positive via PCR, with viral agents being the most common (57% of positive cases).
- Viral meningitis was diagnosed for the first time in routine clinical practice in Ethiopia.
- Despite a high rate of antibiotic use (90% of patients), no significant difference in antibiotic duration was observed between PCR-positive and PCR-negative cases.
Conclusions:
- A rapid molecular diagnostic system was successfully implemented in a low-resource setting.
- Viral meningitis is a significant cause of meningitis in Ethiopia, highlighting the need for accurate diagnostics.
- Rapid diagnostics have the potential to guide antibiotic use, but cost remains a barrier for widespread adoption in low-income countries.
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