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. 2018 Dec 20;18(1):684.
doi: 10.1186/s12879-018-3589-4.

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

Guro K Bårnes  1   2 , Esayas Kebede Gudina  3 , Melkamu Berhane  3 , Alemseged Abdissa  3 , Getnet Tesfaw  3 , Gemeda Abebe  3   4 , Siri Laura Feruglio  1 , Dominique A Caugant  5   6 , Hannah Joan Jørgensen  1   7
Affiliations

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

Guro K Bårnes et al. BMC Infect Dis. .

Abstract

Background: 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.

Methods: 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.

Results: 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/mm3 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.

Conclusions: 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.

Keywords: Bacterial meningitis; Cerebrospinal fluid; FilmArray; Multiplex PCR; Viral meningitis.

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Conflict of interest statement

Competing interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

The study obtained ethical approval from the Regional Committees for Medical and Health Research Ethics in Norway and the Jimma University Institutional Review Board of the Institute of Health. Study information was given in the local language and written informed consent was obtained from all participants, or by parents or adult care takers in the case of children under the age of 16.

Consent for publication

Not applicable. This manuscript does not contain any individual persons’ data.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study participants and results from analyses of cerebrospinal fluid (CSF) samples using FilmArray and culture with respect to detection of a microorganism (positive) or not (negative). Flow chart of study participants, demographics and CSF samples
Fig. 2
Fig. 2
Etiological agents detected in cerebrospinal fluid (CSF) samples from patients with suspected meningitis using FilmArray and culture. Pie chart of etiological agents detected in CSF samples from patients with suspected meningitis
See this image and copyright information in PMC

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