Efficiency of Real-Time PCR in the Diagnosis of Community-Acquired Bacterial Meningitis in Children

Objectives: Community-acquired bacterial meningitis (CABM) is a life-threatening condition and remains a public health concern despite various efforts to prevent it. This study aimed to detect the bacteria causing CABM in children by Real-Time PCR. Methods: In total, 178 Cerebrospinal fluid (CSF) samples from suspected meningitis cases were collected and subjected to cell count, biochemical, microbiological, and molecular analysis. Bacteria grown on blood and chocolate agar were identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). DNA from CSF was extracted and used to detect bacteria by Real-Time PCR using TaqMan Probe. Results: Fifty (28.09%) patients were diagnosed with confirmed meningitis. Of them, 46 (25.84%) were Real-Time PCR, and four (2.25%) were culture and Real-Time PCR positive. Out of 50 bacteria detected, S. pneumoniae (n=35, 19.7%) was the leading causative bacteria and was followed by H. influenzae (seven, 3.93%), E. coli (five, 2.80%), S. agalactiae (two, 1.12%), and N. meningitidis (one, 0.56%). Most of the S. pneumoniae (18 isolates, 51.4%) were isolated from 3-24 months of children, and in neonates, E. coli was the predominant bacteria. When CSF culture was the gold standard for diagnosis, the sensitivity and specificity of Real-Time PCR for S. pneumoniae were 100% (95%CI: 15.81-100%) and 81.25% (95%CI: 74.69-86.73%), respectively. Conclusion: Streptococcus pneumoniae remains the leading organism of CABM in children despite vaccination and advancement in diagnosis. Real-time PCR has emerged as a vibrant diagnostic molecular appliance. Hence, Regular surveillance is crucial to curb the burdens and trends of CABM in children.