RESUMO
Immediate prevention of meningococcal disease relies in part on the prompt treatment with antibiotics of household and other close contacts of cases; however intervention with effective vaccination relies on identification of serogroup-causing strains. Parenteral antibiotic for patient with suspected meningococcal disease before hospital admission is currently recommended. Laboratory standard methods are hindered by failure to detect bacteria by this medical approach to improve patient prognosis. We assessed two polymerase chain reaction (PCR) assays to detect (crgA) and define the serogroups (siaD, orf-2, and ctrA) of Neisseria meningitidis in 120 cerebrospinal fluid (CSF) samples from positive cases (culture or antigen detection or direct smear). The PCR sensitivity for the identification of N. meningitidis was 100 percent (95 percent confidence interval, CI, 96-100 percent) compared to a sensitivity of 46 percent for culture (95 percent CI 37-55 percent), 61 percent for latex agglutination test (95 percent CI 52-70 percent), and 68 percent for Gram stain (95 percent CI 59-76 percent); PCR specificity was 97 percent (95 percent CI 82-100 percent). PCR correctly identified the serogroups A, B, C, W135, Y, and X in CSF samples with a sensitivity of 88 percent (95 percent CI 80-93 percent); the primer sets were 100 percent specific. The introduction of PCR-based assays shall increase laboratory confirmed cases, consequently enhancing surveillance of meningococcal disease.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Proteínas de Bactérias , Líquido Cefalorraquidiano/microbiologia , DNA Bacteriano/classificação , Meningite Meningocócica/diagnóstico , Neisseria meningitidis/genética , Reação em Cadeia da Polimerase , Fatores de Transcrição , Meningite Meningocócica/classificação , Meningite Meningocócica/microbiologia , Neisseria meningitidis/classificação , Neisseria meningitidis/isolamento & purificação , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , SorotipagemRESUMO
Se estudiaron las meningitis meningocóccicas en la ciudad de Rivera en el último semestre de 1993. En este brote epidémico (tasa de ataque de 15,6/100.000 habitantes), pudo recuperarse el germen en 93 por ciento de los casos, aislándose Neisseria meningiditis del serogrupo C, serotipo 2b, Beta-lactamasa negativa. La forma de presentación clínica fue la habitual de las meningoencefalitis supuradas, siendo buena la evolución e indistinta con el tratamiento con penicilina o ceftriaxona. Se detectaron 42 por ciento de portadores entre las personas que cohabitaban