Guiver M, Borrow R
Manchester Public Health Laboratory, Withington Hospital, Manchester, UK.
Methods Mol Med. 2001;67:23-39. doi: 10.1385/1-59259-149-3:23.
Nonculture diagnosis is of increasing importance in maximizing case ascertainment of disease owing to Neisseria meningitidis (1). In the United Kingdom (UK), greater use of pre-admission antibiotics has lead to a steady decline in the total number of cases confirmed by culture, compared to the number reported to the Office for National Statistics (ONS). In addition, since the introduction of serogroup C oligosaccharide-protein conjugate vaccine (2) in the UK and its imminent introduction elsewhere, it is necessary to maximize case ascertainment to determine the true level of disease in the population and establish the impact of vaccination programs. Although serodiagnosis is available for confirmation, results are retrospective and often inconclusive (1). Amplification by polymerase chain reaction (PCR) provides a rapid, highly sensitive, and specific method for detecting meningococcal DNA from clinical samples. A number of assays have been described, some of which provide additional information about serological markers such as serogroup, serotype, and serosubtype (3-10). The introduction of PCR at the UK Public Health Laboratory Service (PHLS) Meningococcal Reference Unit (MRU) has resulted in a dramatic increase in the number of confirmed cases of meningococcal disease (11). In 1998 an additional 56% of cases were confirmed by PCR alone compared to those confirmed by culture only.
由于脑膜炎奈瑟菌，非培养诊断对于最大限度地确诊疾病病例变得越来越重要(1)。在英国，与向国家统计局(ONS)报告的病例数相比，入院前抗生素使用的增加导致培养确诊的病例总数稳步下降。此外，自英国引入C群寡糖-蛋白结合疫苗(2)并即将在其他地方引入以来，有必要最大限度地确诊病例，以确定人群中疾病的真实水平，并确定疫苗接种计划的影响。虽然血清学诊断可用于确诊，但结果是回顾性的，而且往往没有定论(1)。聚合酶链反应(PCR)扩增提供了一种从临床样本中检测脑膜炎球菌DNA的快速、高度灵敏且特异的方法。已经描述了许多检测方法，其中一些方法还提供了有关血清学标志物的额外信息，如血清群、血清型和血清亚型(3 - 10)。英国公共卫生实验室服务(PHLS)脑膜炎球菌参考单位(MRU)引入PCR后，脑膜炎球菌病确诊病例数大幅增加(11)。1998年，仅通过PCR确诊的病例比仅通过培养确诊的病例多56%。
