Khalid, Muhammad

Saleem, Ali Faisal

English

eCommons@AKU

eCommons@AKUDepartment of Paediatrics and Child Health Division of Woman and Child HealthNovember 2017Concordance of cerebrospinal fluid latex particleagglutination test with CSF and blood cultureamong children with acute bacterial meningitisMuhammad KhalidAga Khan UniversityAli Faisal SaleemAga Khan University, ali.saleem@aku.eduFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_women_childhealth_paediatrPart of the Pediatrics CommonsRecommended CitationKhalid, M., Saleem, A. F. (2017). Concordance of cerebrospinal fluid latex particle agglutination test with CSF and blood cultureamong children with acute bacterial meningitis. Journal of Pakistan Medical Association, 67(11), 1783-1784.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_women_childhealth_paediatr/447Vol. 67, No. 11, November 20171783LETTER TO THE EDITORConcordance of cerebrospinal fluid latex particle agglutination test with CSFand blood culture among children with acute bacterial meningitisMuhammad Khalid, Ali Faisal SaleemMadam, Acute Bacterial Meningitis (ABM) is potentiallylife threatening central nervous system infection, which isestimated to affect ~~ 5, 00,000 children worldwide with10% mortality.1 Latex Particle Agglutination (LPA) is arapid diagnostic test for identification of bacterialantigens in CSF in ABM.  It requires only 0.5-1.0 ml CSF tocarry out the test, results are available in 10-15 minutesand it could be useful in the diagnosis of partially treatedmeningitis. Compared to CSF culture LPA had a sensitivityof 66.66%, specificity of 87.91%, positive predictive value(PPV) of 35.29% and negative predictive value (NPV) of96.38%.2We conducted a retrospective data analysis of 432paediatric patients admitted at Aga Khan UniversityHospital (ERC # 3791-Ped-ERC-15) of age 1 month - 16years, discharged with diagnosis of ABM (ICD-9 codes 320and 320.9) between January 2012 - December 2014,aimed to evaluate the reliability and accuracy of LPA testin rapid diagnosis of ABM by comparative evaluation withCSF and blood cultures. Children with post-surgicalmeningitis, TBM, malignancy, absent CSF report (doneoutside) and neonates were excluded from the study.Finally 231 children were included in study. Data wascollected on demographic variables and laboratoryinvestigations.Our study consisted of 146 males (63.2%). Median age was41 months and median hospital stay was 4 days (range 1-48). Positive CSF culture in 7 cases included streptococcusspecies in three cases and one case of each corynebacteriumspecies, enterococcus species, pseudomonas species andAcinetobacter species respectively. CSF LPA was positive inonly 2 (1.32%) children (Table). Both of these cases wereunder 1 year of age. LPA detected H. influenza andstreptococcus pneumoniae in these cases whereas bloodand CSF culture were negative. Only 23 (10.5%) of 219blood cultures were positive. Thirteen (57%) of these caseswere < 12 months of age. Gram negative micro-organisms[Salmonella, Klebsiella pneumoniae, Burkholderia cepaciaand Acinetobacter] were identified in seven cases where asremaining cases were gram positive pathogens[Streptococcus and Staphylococcus (both aureus and non-aureus)].In accordance to the study by Ghotaslou et al3 whereCSF culture was positive in 3.97% of cases, our studyhad positive CSF culture in 3.03 % of the cases. LPAtest in our study was positive in 1.32 % of caseswhereas it was positive in 5.05% of cases from anIranian study3 however study by Mishra et al4 showedpositive rates of 19.3%. Sensitivity, specificity, PPV andNPV of LPA test was 0%, 98.51%, 0 % and 97.1%respectively in our study. Positive and negativepredictive value (PPV, NPV) is the probability of thedisease will be present or absent when screening testis positive or negative respectively.Due to low yield and high cost LPA should not beroutinely used as screening tool for diagnosis of acutebacterial meningitis. Test selection in ABM needs to beindividualized on the basis of history, examination,vaccination status and prior use of antibiotics. No test canreplace the utility of cultures.Disclaimer: None.Conflict of Interest: None.Funding Sources: Dr. Muhammad Khalid is traineeFellow in Pediatric Infectious Diseases supported by GrantDepartment of Pediatrics and Child Health, Aga Khan University Hospital.Karachi.Correspondence: Ali Faisal Saleem. Email: ali.saleem@aku.eduTable: Clinical and laboratory features of study population (N=231).GenderMale                                                                                                                        146 (63.2%)Female                                                                                                                    85 (36.8%)AgeMean                                                                                                             56.27±56.13 monthsMedian                                                                                                                    41 monthsRange                                                                                                                  1 - 191 monthsCSF LPA +ve                                                                                                            2 / 152 (1.32%)CSF culture +ve                                                                                                           7 (3.03%)Blood culture +ve                                                                                                23 / 219 (10.5%)Children with +ve blood culture and concomitant +ve CSF culture               0 / 197   (0 %)Children with +ve blood culture and concomitant +ve CSF LPA                     0 / 218   (0 %)CSF: Cerebro Spinal Fluid. LPA: Latex Particle Agglutination.J Pak Med Assoc1784 M. Khalid, A. F. SaleemNumber 1 D43 TW007585-01 from the National Instituteof Health's Fogarty International Center.References1. Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis,and antimicrobial treatment of acute bacterial meningitis. ClinMicrobiol Rev. 2010; 23: 467-92.2. Shenoy B, Biradar S. Latex Agglutination Test (LAT)-For rapiddiagnosis of acute bacterial meningitis. Paed Infect Dis 2014; 6:150-2.3. Ghotaslou R, Farajnia S, Yeganeh F, Abdoli-Oskouei S, Rezaee MA,Barzegar M. Detection of acute childhood meningitis by PCR,culture and agglutination tests in Tabriz, Iran. Acta Medica Iranica.2012; 50: 192.4. Mishra B, Mahaseth C, Rayamajhi A. Latex agglutination test forearly detection of causative organism in acute bacterialmeningitis. J Nepal Paediatr Soc. 2013; 33: 34-8.

Concordance of cerebrospinal fluid latex particle agglutination test with CSF and blood culture among children with acute bacterial meningitis

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Concordance of cerebrospinal fluid latex particle agglutination test with CSF and blood culture among children with acute bacterial meningitis

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