Background As part of the global Invasive Bacterial Vaccine-Preventable Diseases Surveillance Network, 12 African countries referred cerebrospinal fluid (CSF) samples to South Africa’s regional reference laboratory. We evaluated the utility of real-time polymerase chain reaction (PCR) in detecting and serotyping/grouping Haemophilus influenzae, Neisseria meningitidis, and Streptococcus pneumoniae (HNS). Methods From 2008 to 2017, CSF samples collected from children <5 years old with suspected meningitis underwent routine microbiology testing in-country, and 11 680 samples were submitted for HNS PCR at the regional reference laboratory. Unconditional logistic regression, with adjustment for geographic location, was performed to identify factors associated with PCR positivity. Results The overall HNS PCR positivity rate for all countries was 10% (1195 of 11 626 samples). In samples with both PCR and culture results, HNS PCR positivity was 11% (744 of 6747 samples), and HNS culture positivity was 3% (207 of 6747). Molecular serotype/serogroup was assigned in 75% of PCR-positive specimens (762 of 1016). Compared with PCR-negative CSF samples, PCR-positive samples were more often turbid (adjusted odds ratio, 6.80; 95% confidence interval, 5.67–8.17) and xanthochromic (1.72; 1.29–2.28), had elevated white blood cell counts (6.13; 4.71–7.99) and high protein concentrations (5.80; 4.34–7.75), and were more often HNS culture positive (32.70; 23.18–46.12). Conclusion PCR increased detection of vaccine-preventable bacterial meningitis in countries where confirmation of suspected meningitis cases is impeded by limited culture capacity.

中文翻译：

---

分子检测在南部和东部非洲国家儿科脑膜炎监测中的作用，2008-2017 年

背景 作为全球侵入性细菌疫苗可预防疾病监测网络的一部分，12 个非洲国家将脑脊液 (CSF) 样本转交给南非的区域参考实验室。我们评估了实时聚合酶链反应 (PCR) 在检测和血清分型/分组流感嗜血杆菌、脑膜炎奈瑟菌和肺炎链球菌 (HNS) 中的效用。方法 2008年至2017年，对5岁以下疑似脑膜炎患儿的脑脊液样本在国内进行常规微生物学检测，11 680份样本送区域参比实验室进行HNS PCR。进行了对地理位置进行调整的无条件逻辑回归以确定与 PCR 阳性相关的因素。结果所有国家的总体 HNS PCR 阳性率为 10%（11 626 个样本中的 1195 个）。在具有 PCR 和培养结果的样本中，HNS PCR 阳性率为 11%（6747 个样本中的 744 个），HNS 培养阳性率为 3%（6747 个样本中的 207 个）。75% 的 PCR 阳性样本（1016 份中的 762 份）分配了分子血清型/血清组。与 PCR 阴性 CSF 样本相比，PCR 阳性样本通常更浑浊（调整优势比，6.80；95% 置信区间，5.67-8.17）和黄色（1.72；1.29-2.28），白细胞计数升高（6.13 ; 4.71–7.99) 和高蛋白浓度 (5.80; 4.34–7.75)，并且更常见的是 HNS 培养阳性 (32.70; 23.18–46.12)。