Ulster Hospital Dundonald, BT16 1RH Belfast, UK.
Diagn Microbiol Infect Dis. 2011 Aug;70(4):427-34. doi: 10.1016/j.diagmicrobio.2011.03.018. Epub 2011 Jun 11.
Early meningococcal disease (MD) diagnosis is difficult. We assessed rapid molecular testing of respiratory specimens. We performed genotyping of respiratory swabs, blood, and cerebrospinal fluid from children with suspected disease and nasal swabs (NSs) from matched controls. Thirty-nine of 104 suspected cases had confirmed disease. Four controls were carriers. Throat swab ctrA and porA testing for detection of disease gave a sensitivity of 81% (17/21), specificity of 100% (44/44), positive predictive value (PPV) of 100% (17/17), negative predictive value (NPV) of 92% (44/48), and relative risk of 12. NS ctrA and porA testing gave a sensitivity of 51% (20/39), specificity of 95% (62/65), PPV of 87% (20/23), NPV of 77% (62/81), and relative risk of 4. Including only the 86 NSs taken within 48 h of presentation, the results were sensitivity of 60% (18/30), specificity of 96% (54/56), PPV of 90% (18/20), NPV of 82% (54/66), and relative risk of 5. Swab type agreement was excellent (kappa 0.80, P < 0.001). There was exact phylogenetic agreement from different specimen sites for individuals. Carried genosubtypes were P1.7 and P1.21-7. Prehospital rapid molecular testing of easily obtained respiratory specimens could accelerate diagnosis of MD.
早期脑膜炎奈瑟菌病 (MD) 诊断困难。我们评估了呼吸道标本的快速分子检测。我们对疑似疾病患儿的呼吸道拭子、血液和脑脊液以及匹配对照者的鼻拭子（NS）进行了基因分型。104 例疑似病例中有 39 例确诊。4 例对照者为携带者。用于检测疾病的咽拭子 ctrA 和 porA 检测的敏感性为 81%（17/21），特异性为 100%（44/44），阳性预测值（PPV）为 100%（17/17），阴性预测值（NPV）为 92%（44/48），相对风险为 12。NS ctrA 和 porA 检测的敏感性为 51%（20/39），特异性为 95%（62/65），PPV 为 87%（20/23），NPV 为 77%（62/81），相对风险为 4。仅包括发病后 48 小时内采集的 86 份 NS，结果为敏感性 60%（18/30），特异性 96%（54/56），PPV 为 90%（18/20），NPV 为 82%（54/66），相对风险为 5。拭子类型一致性极好（kappa 值 0.80，P<0.001）。不同标本部位的个体之间存在完全一致的进化关系。携带的基因亚型为 P1.7 和 P1.21-7。容易获得的呼吸道标本的院前快速分子检测可加速 MD 的诊断。
