Real-time qPCR improves meningitis pathogen detection in invasive bacterial-vaccine preventable disease surveillance in Fiji

As part of the World Health Organization Invasive Bacterial-Vaccine Preventable Diseases (IB-VPD)
surveillance in Suva, Fiji, cerebrospinal fluid (CSF) samples from suspected meningitis patients of all
ages were examined by traditional methods (culture, Gram stain, and latex agglutination for bacterial
antigen) and qPCR for Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae.
Of 266 samples tested, pathogens were identified in 47 (17.7%). S. pneumoniae was the most common
pathogen detected (n=17) followed by N. meningitidis (n=13). The use of qPCR significantly increased
detection of IB-VPD pathogens (P=0.0001): of 35 samples that were qPCR positive for S. pneumoniae,
N. meningitidis, and H. influenzae, only 10 were culture positive. This was particularly relevant for
N. meningitidis, as only 1/13 cases was culture positive. Molecular serotyping by microarray was used
to determine pneumococcal serotypes from 9 of 16 (56%) of samples using DNA directly extracted
from CSF specimens. Results indicate that qPCR significantly increases detection of S. pneumoniae,
N. meningitidis, and H. influenzae in CSF, and that applic