New molecular tools for meningitis diagnostics in Ethiopia - a necessary step towards improving antimicrobial prescription

• Published in: BMC infectious diseases 2018-12, Vol.18 (1), p.684-684, Article 684
• Main Authors: Bårnes, Guro K, Gudina, Esayas Kebede, Berhane, Melkamu, Abdissa, Alemseged, Tesfaw, Getnet, Abebe, Gemeda, Feruglio, Siri Laura, Caugant, Dominique A, Jørgensen, Hannah Joan
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Adults; Aged; Aged, 80 and over; Anti-infective agents; Anti-Infective Agents - classification; Anti-Infective Agents - economics; Anti-Infective Agents - therapeutic use; Antibiotics; Antimicrobial agents; Aseptic meningitis; Bacterial meningitis; Cell culture; Cerebrospinal fluid; Child; Child, Preschool; Diagnosis; Diagnosis, Differential; Diagnostic systems; Disease; Drug resistance; Economic aspects; Encephalitis; Epidemiology; Ethiopia; Female; FilmArray; Fungi; Health care; Health Resources; Hospitals, Teaching - economics; Humans; Income; Infant; Infant, Newborn; Infectious diseases; Laboratories; Low income groups; Male; Meningitis; Meningitis - cerebrospinal fluid; Meningitis - diagnosis; Meningitis - drug therapy; Meningitis - genetics; Meningitis, Bacterial - cerebrospinal fluid; Meningitis, Bacterial - diagnosis; Meningitis, Bacterial - drug therapy; Meningitis, Viral - cerebrospinal fluid; Meningitis, Viral - diagnosis; Meningitis, Viral - drug therapy; Microorganisms; Microscopy; Middle Aged; Molecular Diagnostic Techniques - economics; Molecular Diagnostic Techniques - methods; Molecular Diagnostic Techniques - trends; Mortality; Multiplex PCR; Multiplex Polymerase Chain Reaction - economics; Neonates; Patient outcomes; Patients; Pediatrics; Polymerase chain reaction; Practice Patterns, Physicians' - economics; Practice Patterns, Physicians' - standards; Practice Patterns, Physicians' - trends; Quality Improvement; Teaching hospitals; Viral meningitis; Viruses; Young Adult
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-018-3589-4

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. 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. 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/mm 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. 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.