Jbara Ibrahim, Baysallar Mehmet, Kiliç Abdullah, Yetişer Sertaç, Unay Bülent, Açikel Cengizhan, Yapar Mehmet, Doğanci Levent
Gülhane Askeri Tip Akademisi, Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dali, Ankara.
Mikrobiyol Bul. 2007 Oct;41(4):495-502.
Although the availability of effective antimicrobial therapy, both otitis media with effusion (OME) and acute bacterial meningitis (ABM) are still important infections for children, leading serious health problems. The most frequently isolated bacteria from cerebrospinal fluid (CSF) of ABM patients are Haemophilus influenzae type b, Neisseria meningitidis and Streptococcus pneumoniae, and middle ear effusion (MEE) samples of OME patients are H. influenzae, S. pneumoniae, Moraxella catarrhalis, respectively. Since they are fastidious bacteria, various problems may arise in the rapid diagnosis in both ABM and OME settings. In this study, the diagnostic value of polymerase chain reaction (PCR) has been searched for the detection of bacterial DNA in CSF and MEE specimens and evaluated in comparison to conventional culture method accepted as the "gold standard". A total of 75 samples (53 CSF, 22 MEE) collected from meningitis and OME suspected children were included in the study. With the conventional culture method, one S. pneumoniae strain was isolated from a CSF sample, and one H. influenzae (non-type b) and two M. catarrhalis strains were isolated from three of MEE samples (total isolation rate: %5.3; 4/75). Standard PCR protocol was applied for the detection of H. influenzae, while multiplex PCR protocol was used for M. catarrhalis and S. pneumoniae, since H. influenzae and S. pneumoniae amplification products were of similar size. PCR revealed genomic DNA sequences of S. pneumoniae from five of the CSF samples, while three H. influenzae, three M. catarrhalis and two S. pneumoniae+M. catarrhalis were detected from MEE samples (total detection rate: %17.3; 13/75). Sensitivity and specificity rates of PCR method were found as 100% and 92.3% for CSF samples, and 100% and 73.7% for MEE samples, respectively, with a total sensitivity of 100%, specificity of 87.3%, positive predictive value of 30.8%, and negative predictive value of 100%. As a result it was concluded that PCR method could be considered as a rapid, reliable and feasible method for the detection of the most common fastidious bacteria that lead to meningitis and OME.
尽管有有效的抗菌治疗方法，但中耳积液（OME）和急性细菌性脑膜炎（ABM）对儿童来说仍是重要的感染性疾病，会引发严重的健康问题。ABM患者脑脊液（CSF）中最常分离出的细菌是b型流感嗜血杆菌、脑膜炎奈瑟菌和肺炎链球菌，而OME患者的中耳积液（MEE）样本中分别是流感嗜血杆菌、肺炎链球菌、卡他莫拉菌。由于它们是苛养菌，在ABM和OME的快速诊断中可能会出现各种问题。在本研究中，探索了聚合酶链反应（PCR）在检测CSF和MEE标本中细菌DNA的诊断价值，并与被视为“金标准”的传统培养方法进行比较评估。本研究共纳入了从疑似脑膜炎和OME的儿童中采集的75份样本（53份CSF，22份MEE）。采用传统培养方法，从一份CSF样本中分离出一株肺炎链球菌，从三份MEE样本中分离出一株流感嗜血杆菌（非b型）和两株卡他莫拉菌（总分离率：5.3%；4/75）。由于流感嗜血杆菌和肺炎链球菌的扩增产物大小相似，因此采用标准PCR方案检测流感嗜血杆菌，采用多重PCR方案检测卡他莫拉菌和肺炎链球菌。PCR从五份CSF样本中检测到肺炎链球菌的基因组DNA序列，而从MEE样本中检测到三株流感嗜血杆菌、三株卡他莫拉菌和两株肺炎链球菌+卡他莫拉菌（总检测率：17.3%；13/75）。PCR方法对CSF样本的敏感性和特异性分别为100%和92.3%，对MEE样本的敏感性和特异性分别为100%和73.7%，总敏感性为100%，特异性为87.3% , 阳性预测值为30.8%，阴性预测值为100%。结果得出结论，PCR方法可被视为一种快速、可靠且可行的方法，用于检测导致脑膜炎和OME的最常见苛养菌。
