Abstract
A central nervous system (CNS) infection, such as meningitis, is a serious and life-threatening condition. Bacterial meningitis can be severe and may result in brain damage, disability or even death. Rapid diagnosis of CNS infections and identification of the pathogenic microorganisms are needed to improve the patient outcome. Bacterial culture of a patient’s cerebrospinal fluid (CSF) is currently considered the “gold standard” for diagnosing bacterial meningitis. From the CSF cultures researchers can assess the in vitro susceptibility of the causative microorganism to determine the best antibiotic treatment. However, many of the culture assays, such as microscopy and the latex agglutination test are not sensitive. To enhance pathogen detection in CSF samples we developed a multi-target real-time PCR assay that can rapidly identify six different microorganisms: Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Streptococcus agalactiae, Listeria monocytogenes and Cryptococcus neoformans. In this study we applied this PCR analysis to 296 CSF samples from patients who were suspected of having meningitis. Of the 296 samples that were examined, 59 samples were positive according to the CSF culture and/or molecular assays. Forty-six CSF samples were positive for both the CSF culture and our real-time PCR assay, while 13 samples were positive for the real-time PCR but negative for the traditional assays. This discrepancy may have been caused by the fact that these samples were collected from 23 patients who were treated with antimicrobials before CSF sampling.

References
Brouwer, M. C., Tunkel, A. R., & van de Beek, D. (2010). Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clinical Microbiological Review, 23, 467–492.
Van Gastel, E., Bruynseels, P., Verstrepen, W., & Mertens, A. (2007). Evaluation of a real-time polymerase chain reaction assay for the diagnosis of pneumococcal and meningococcal meningitis in a tertiary care hospital. European Journal of Clinical Microbiology and Infectious Diseases, 26, 651–653.
Riordan, A. (2010). The implications of vaccines for prevention of bacterial meningitis. Current Opinion in Neurology, 23(3), 319–324.
Lu, J. J., Perng, C. L., Lee, S. Y., & Wan, C. C. (2000). Use of PCR with universal primers and restriction endonuclease digestions for detection and identification of common bacterial pathogens in cerebrospinal fluid. Journal of Clinical Microbiology, 38, 2076–2080.
Hussein, A. S., & Shafran, S. D. (2000). Acute bacterial meningitis in adults. A 12-year review. Medicine, 79, 360–368.
Vaneechoutte, M., & Van Eldere, J. (1997). The possibilities and limitations of nucleic acid amplification technology in diagnostic microbiology. Journal of Medical Microbiology, 46, 188–194.
Sugiura, Y., Homma, M., & Yamamoto, T. (2005). Difficulty in diagnosing chronic meningitis caused by capsule-deficient Cryptococcus neoformans. Journal of Neurology, Neurosurgery and Psychiatry, 76, 1460–1461.
Bialek, R., Weiss, M., Bekure-Nemariam, K., Najvar, L. K., Alberdi, M. B., Graybill, J. R., et al. (2002). Detection of Cryptococcus neoformans DNA in tissue samples by nested and real-time PCR assays. Clinical and Diagnostic Laboratory Immunology, 9, 461–469.
Veron, V., Simon, S., Blanchet, D., & Aznar, C. (2009). Real-time polymerase chain reaction detection of Cryptococcus neoformans and Cryptococcus gattii in human samples. Diagnostic Microbiology and Infectious Disease, 65, 69–72.
Enting, R. H., Spanjaard, L., van de Beek, D., Hensen, E. F., de Gans, J., & Dankert, J. (1996). Antimicrobial susceptibility of Haemophilus influenzae, Neisseria meningitidis and Streptococcus pneumoniae isolates causing meningitis in The Netherlands, 1993–1994. Journal of Antimicrobial Chemotherapy, 38, 777–786.
Espy, M. J., Uhl, J. R., Sloan, L. M., Buckwalter, S. P., Jones, M. F., Vetter, E. A., et al. (2006). Real-time PCR in clinical microbiology: Applications for routine laboratory testing. Clinical Microbiology Reviews, 19, 165–256.
Failace, L., Wagner, M., Chesky, M., Scalco, R., & Jobim, L. F. (2005). Simultaneous detection of Neisseria meningitidis, Haemophilus influenzae and Streptococcus spp. by polymerase chain reaction for the diagnosis of bacterial meningitis. Arquivos de Neuropsiquiatria, 63, 920–924.
Garcia-Hermoso, D., Janbon, G., & Dromer, F. (1999). Epidemiological evidence for dormant Cryptococcus neoformans infection. Journal of Clinical Microbiology, 37, 3204–3209.
Greisen, K., Loeffelholz, M., Purohit, A., & Leong, D. (1994). PCR primers and probes for the 16S rRNA gene of most species of pathogenic bacteria, including bacteria found in cerebrospinal fluid. Journal of Clinical Microbiology, 32, 335–351.
Diggle, M. A., Edwards, G. F. S., & Clarke, S. C. (2001). Automation of fluorescence-based PCR for confirmation of meningococcal disease. Journal of Clinical Microbiology, 39, 4518–4519.
Diggle, M. A., & Clarke, S. C. (2006). Molecular methods for the detection and characterization of Neisseria meningitidis. Expert Review of Molecular Diagnostics, 6, 79–87.
Edwards, U., Rogall, T., Blöcker, H., Emde, M., & Böttger, E. C. (1989). Isolation and direct complete nucleotide determination of entire genes. Characterization of a gene coding for 16S ribosomal RNA. Nucleic Acid Research, 17, 7843–7853.
Van de Beek, D., de Gans, J., Tunkel, A. R., & Wijdicks, E. F. (2006). Community-acquired bacterial meningitis in adults. New England Journal of Medicine, 354, 44–53.
Bäckman, A., Lantz, P., Radström, P., & Olcén, P. (1999). Evaluation of an extended diagnostic PCR assay for detection and verification of the common causes of bacterial meningitis in CSF and other biological samples. Molecular and Cellular Probes, 13, 49–60.
Corless, C. E., Guiver, M., Borrow, R., Edwards-Jones, V., Fox, A. J., & Kaczmarski, E. B. (2001). Simultaneous detection of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae in suspected cases of meningitis and septicemia using real-time PCR. Journal of Clinical Microbiology, 39, 1553–1558.
Deutch, S., Møller, J. K., & Ostergaard, L. (2008). Combined assay for two-hour identification of Streptococcus pneumoniae and Neisseria meningitidis and concomitant detection of 16S ribosomal DNA in cerebrospinal fluid by real-time PCR. Scandinavian Journal of Infectious Diseases, 40, 607–614.
Author information
Authors and Affiliations
Corresponding author
Additional information
Marco Favaro and Carla Fontana contributed equally to this study.
Rights and permissions
About this article
Cite this article
Favaro, M., Savini, V., Favalli, C. et al. A Multi-Target Real-Time PCR Assay for Rapid Identification of Meningitis-Associated Microorganisms. Mol Biotechnol 53, 74–79 (2013). https://doi.org/10.1007/s12033-012-9534-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12033-012-9534-7