title: Molecular testing of respiratory swabs aids early recognition of meningococcal disease in children.
abstract: 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.
authors.affiliation: Ulster Hospital Dundonald, BT16 1RH Belfast, UK. k.dunlop@doctors.org.uk
authors.forename: Kathryn Anne
authors.initials: KA
authors.lastname: Dunlop
authors.forename: Peter
authors.initials: P
authors.lastname: Coyle
authors.forename: Suzanne
authors.initials: S
authors.lastname: Mitchell
authors.forename: Derek
authors.initials: D
authors.lastname: Fairley
authors.forename: Hugh
authors.initials: H
authors.lastname: O'Neill
authors.forename: Paul
authors.initials: P
authors.lastname: Jackson
authors.forename: Michael David
authors.initials: MD
authors.lastname: Shields
mesh_terms: D000293:Adolescent; D001426:Bacterial Proteins / Q000235:genetics; D001431:Bacteriological Techniques / Q000379:methods*; D001769:Blood / Q000382:microbiology; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008589:Meningococcal Infections / Q000175:diagnosis*; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D009297:Nasal Mucosa / Q000382:microbiology*; D009345:Neisseria meningitidis / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D010614:Pharynx / Q000382:microbiology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
chemical_list: D001426:Bacterial Proteins