Impact Of The Real Time Pcr In The Diagnosis Of Acute Bacterial Meningitis In Infants In A Tertiary Health Care Center In India

Purpose: Detection of pathogens causing acute bacterial meningitis (AMB) in infants by conventional and molecular methods (Real time PCR). Methods & Materials: 62 Cerebro spinal fluid (CSF) were collected from March, 2015 to December, 2017. All samples were processed in the department of Microbiology, AIIMS, following standard Microbiological diagnostic procedure. Culture of the CSF was performed using Blood agar and Mac Conkey agar. Brain heart infusion broth with 0.5% yeast extract was used for culture of L. monocytogenes. Bacterial antigen from CSF was detected by Latex agglutination test (LAT) using Directigen meningitis Kit (BD, USA) and DNA from CSF was extracted by using QIAamp DNA mini Kit (Qiagen). Culture, latex agglutination and Real time PCR were performed to test each sample for S. agalactiae, E. coli and L. monocytogenes. Results: Overall 62 CSF samples, 28 neonates and 34 Infants were included in this study. All samples were processed by conventional and molecular methods, 17 (27.41%) were positive for the different bacteria. Out of the 17 organisms, E. coli 5(29.41%), S. agalactiae 2(11.76%), S. pneumoniae 8 (47.05%), and H. influenzae 2(11.76%) were detected respectively. S. agalactiae were positive in neonates (only by Real time PCR). Among the E. coli (one was positive by latex, and one was by both LA and culture), but all were positive by Real time PCR. Similarly, three E. coli were observed in neonates. However, all S. pneumoniae and H. influenzae were detected only by Real time PCR in infants. Mean glucose and protein level was (45 and 225/dl) respectively. PMN cell count was high. Conclusion: Real time PCR has emerged as a powerful molecular tool for the diagnosis of acute bacterial meningitis in infants where there is the need for urgent diagnosis and treatment. In this study, S. pneuminae (47.05%) was the leading organism in infants where as in neonates, E. coli (17.64%). was the most frequently identified pathogen followed by S. agalactiae (11.76%).