Skip to main content
  • ASM
    • Antimicrobial Agents and Chemotherapy
    • Applied and Environmental Microbiology
    • Clinical Microbiology Reviews
    • Clinical and Vaccine Immunology
    • EcoSal Plus
    • Eukaryotic Cell
    • Infection and Immunity
    • Journal of Bacteriology
    • Journal of Clinical Microbiology
    • Journal of Microbiology & Biology Education
    • Journal of Virology
    • mBio
    • Microbiology and Molecular Biology Reviews
    • Microbiology Resource Announcements
    • Microbiology Spectrum
    • Molecular and Cellular Biology
    • mSphere
    • mSystems
  • Log in
  • My alerts
  • My Cart

Main menu

  • Home
  • Articles
    • Current Issue
    • Accepted Manuscripts
    • COVID-19 Special Collection
    • Archive
    • Minireviews
  • For Authors
    • Submit a Manuscript
    • Scope
    • Editorial Policy
    • Submission, Review, & Publication Processes
    • Organization and Format
    • Errata, Author Corrections, Retractions
    • Illustrations and Tables
    • Nomenclature
    • Abbreviations and Conventions
    • Publication Fees
    • Ethics Resources and Policies
  • About the Journal
    • About JCM
    • Editor in Chief
    • Editorial Board
    • For Reviewers
    • For the Media
    • For Librarians
    • For Advertisers
    • Alerts
    • RSS
    • FAQ
  • Subscribe
    • Members
    • Institutions
  • ASM
    • Antimicrobial Agents and Chemotherapy
    • Applied and Environmental Microbiology
    • Clinical Microbiology Reviews
    • Clinical and Vaccine Immunology
    • EcoSal Plus
    • Eukaryotic Cell
    • Infection and Immunity
    • Journal of Bacteriology
    • Journal of Clinical Microbiology
    • Journal of Microbiology & Biology Education
    • Journal of Virology
    • mBio
    • Microbiology and Molecular Biology Reviews
    • Microbiology Resource Announcements
    • Microbiology Spectrum
    • Molecular and Cellular Biology
    • mSphere
    • mSystems

User menu

  • Log in
  • My alerts
  • My Cart

Search

  • Advanced search
Journal of Clinical Microbiology
publisher-logosite-logo

Advanced Search

  • Home
  • Articles
    • Current Issue
    • Accepted Manuscripts
    • COVID-19 Special Collection
    • Archive
    • Minireviews
  • For Authors
    • Submit a Manuscript
    • Scope
    • Editorial Policy
    • Submission, Review, & Publication Processes
    • Organization and Format
    • Errata, Author Corrections, Retractions
    • Illustrations and Tables
    • Nomenclature
    • Abbreviations and Conventions
    • Publication Fees
    • Ethics Resources and Policies
  • About the Journal
    • About JCM
    • Editor in Chief
    • Editorial Board
    • For Reviewers
    • For the Media
    • For Librarians
    • For Advertisers
    • Alerts
    • RSS
    • FAQ
  • Subscribe
    • Members
    • Institutions
LETTERS TO THE EDITOR

Comparison of Bacterial Antigen Test and Gram Stain for Detecting Classic Meningitis Bacteria in Cerebrospinal Fluid

Tess Karre, Emily A. Vetter, Jayawant N. Mandrekar, Robin Patel
Tess Karre
Division of Clinical Microbiology Department of Laboratory Medicine and Pathology
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Emily A. Vetter
Division of Clinical Microbiology Department of Laboratory Medicine and Pathology
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jayawant N. Mandrekar
Division of Biomedical Statistics and Informatics
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Robin Patel
Divisions of Clinical Microbiology and Infectious Diseases Department of Medicine Mayo Clinic 200 First St. SW Rochester, Minnesota 55905
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: patel.robin@mayo.edu
DOI: 10.1128/JCM.00153-10
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

The bacterial antigen test (BAT) screens cerebrospinal fluid (CSF) or other body fluids for antigens of classic bacterial meningitis pathogens (i.e., Streptococcus pneumoniae, Haemophilus influenzae type b [Hib], group B Streptococcus species, Neisseria meningitidis, and Escherichia coli K1) (7). The utility of the BAT has been questioned in several published reports (2, 5, 6, 8, 12, 15). Furthermore, changes in the epidemiology of bacterial meningitis related to the pneumococcal, meningococcal, and Hib vaccines have likely affected the positive predictive value of the BAT (1, 3, 9, 10, 12, 16). Consequently, many laboratories have discontinued use of the BAT. However, in the absence of clear recommendations, some laboratories may continue to offer the BAT due to conflicting evidence in the literature (5, 11, 14) or the possibility that the BAT may be valuable in diagnosing bacterial meningitis caused by culture-negative organisms (8).

We retrospectively analyzed 918 CSF specimens from adults and children tested at our institution (Mayo Clinic, Rochester, MN) with the BAT (Wellcogen bacterial antigen kit; Remel, Inc., Lenexa, KS), Gram stain, and culture between January 2000 and March 2009. We further analyzed a subset of these in which at least one of the following criteria was met: (i) positive BAT result, (ii) positive Gram stain result consistent with a classical bacterial meningitis pathogen, or (iii) classical bacterial meningitis pathogen identified by culture from CSF. Forty-two cases were identified.

Results of the BAT and Gram stain were compared (Table 1). In 9 of the culture-negative CSF specimens, the culture of samples (blood or ear drainage) from other sterile body sites yielded classic meningitis organisms. For specimens from CSF, blood, or ear drainage with positive culture results, the results of the BAT and Gram stain were analyzed by organism (Table 2).

For the 3 specimens in which the BAT was positive and the Gram stain was negative, the culture was also positive, rendering the BAT redundant. None of the culture-negative cases were missed by the Gram stain, again making the BAT unnecessary.

To increase the sensitivity of the CSF Gram stain, a cytocentrifugation procedure was implemented in January 2007 (4, 13). All five (12%) Gram stain-negative specimens with classic bacterial meningitis pathogens present (including those in which the BAT was positive) were tested prior to the implementation of the cytocentrifugation procedure. Had these Gram stains been performed using the more sensitive cytocentrifugation protocol, the results may have been positive.

Kiska et al. (8) proposed screening criteria based on CSF indices to decrease unnecessary use of the BAT. Their findings suggested that in cases of previous antibiotic treatment in which culture and Gram stain results may be negative, the BAT still may play a role in the diagnosis of bacterial meningitis. However, the findings of our large, retrospective study indicate that the BAT provides no substantial benefit beyond the Gram stain in screening for bacterial meningitis, even in cases with culture-negative results. Although the BAT may be faster than culture in the Gram stain-negative cases, routine antimicrobials are recommended until all test results are available. This moderate benefit must be contrasted with the risk of a false sense of security with a false-negative BAT, or the risk of a false-positive BAT, which would complicate care decisions.

View this table:
  • View inline
  • View popup
TABLE 1.

Comparison of BAT and Gram stain resultsa

View this table:
  • View inline
  • View popup
TABLE 2.

Specimens with and without classic bacterial meningitis-causing organisms and number not detected by BAT and Gram stain

ACKNOWLEDGMENTS

We gratefully acknowledge the staff in the Mayo Clinic bacteriology laboratory for performing the microbiologic tests described and Thomas E. Grys for his thoughtful review of this letter.

  • Copyright © 2010 American Society for Microbiology

REFERENCES

  1. 1.↵
    Azzari, C., and M. Resti. 2008. Reduction of carriage and transmission of Streptococcus pneumoniae: the beneficial “side effect” of pneumococcal conjugate vaccine. Clin. Infect. Dis. 47 : 997-999.
    OpenUrlCrossRefPubMedWeb of Science
  2. 2.↵
    Barlow, J. F. 1996. Is BAT BAD in CSF? S. D. J. Med. 49 : 85.
    OpenUrlPubMed
  3. 3.↵
    CDC. 2008. Invasive pneumococcal disease in children 5 years after conjugate vaccine introduction—eight states, 1998-2005. MMWR Morb. Mortal. Wkly. Rep. 57 : 144-148.
    OpenUrlPubMed
  4. 4.↵
    Chapin-Robertson, K., S. E. Dahlberg, and S. C. Edberg. 1992. Clinical and laboratory analyses of cytospin-prepared Gram stains for recovery and diagnosis of bacteria from sterile body fluids. J. Clin. Microbiol. 30 : 377-380.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    Das, B. K., R. L. Gurubacharya, T. M. Mohapatra, and O. P. Mishra. 2003. Bacterial antigen detection test in meningitis. Indian J. Pediatr. 70 : 799-801.
    OpenUrlCrossRefPubMed
  6. 6.↵
    Finlay, F. O., H. Witherow, and P. T. Rudd. 1995. Latex agglutination testing in bacterial meningitis. Arch. Dis. Child. 73 : 160-161.
    OpenUrlAbstract/FREE Full Text
  7. 7.↵
    Hayden, R. T., and L. D. Frenkel. 2000. More laboratory testing: greater cost but not necessarily better. Pediatr. Infect. Dis. J. 19 : 290-292.
    OpenUrlCrossRefPubMedWeb of Science
  8. 8.↵
    Kiska, D. L., M. C. Jones, M. E. Mangum, D. Orkiszewski, and P. H. Gilligan. 1995. Quality assurance study of bacterial antigen testing of cerebrospinal fluid. J. Clin. Microbiol. 33 : 1141-1144.
    OpenUrlAbstract/FREE Full Text
  9. 9.↵
    Laval, C. A., F. C. Pimenta, J. G. de Andrade, S. S. Andrade, and A. L. de Andrade. 2003. Progress towards meningitis prevention in the conjugate vaccines era. Braz. J. Infect. Dis. 7 : 315-324.
    OpenUrlPubMed
  10. 10.↵
    Makwana, N., and F. A. Riordan. 2007. Bacterial meningitis: the impact of vaccination. CNS Drugs 21 : 355-366.
    OpenUrlCrossRefPubMed
  11. 11.↵
    Mirdha, B. R., U. Gupta, and R. A. Bhujwala. 1991. Latex agglutination test: an adjunct to the laboratory diagnosis of pyogenic bacterial meningitis. Indian J. Pediatr. 58 : 521-524.
    OpenUrlCrossRefPubMed
  12. 12.↵
    Perkins, M. D., S. Mirrett, and L. B. Reller. 1995. Rapid bacterial antigen detection is not clinically useful. J. Clin. Microbiol. 33 : 1486-1491.
    OpenUrlAbstract/FREE Full Text
  13. 13.↵
    Shanholtzer, C. J., P. J. Schaper, and L. R. Peterson. 1982. Concentrated Gram stain smears prepared with a cytospin centrifuge. J. Clin. Microbiol. 16 : 1052-1056.
    OpenUrlAbstract/FREE Full Text
  14. 14.↵
    Surinder, K., K. Bineeta, and M. Megha. 2007. Latex particle agglutination test as an adjunct to the diagnosis of bacterial meningitis. Indian J. Med. Microbiol. 25 : 395-397.
    OpenUrlPubMed
  15. 15.↵
    Tarafdar, K., S. Rao, R. A. Recco, and M. M. Zaman. 2001. Lack of sensitivity of the latex agglutination test to detect bacterial antigen in the cerebrospinal fluid of patients with culture-negative meningitis. Clin. Infect. Dis. 33 : 406-408.
    OpenUrlCrossRefPubMedWeb of Science
  16. 16.↵
    Theodoridou, M. N., V. A. Vasilopoulou, E. E. Atsali, A. M. Pangalis, G. J. Mostrou, V. P. Syriopoulou, and C. S. Hadjichristodoulou. 2007. Meningitis registry of hospitalized cases in children: epidemiological patterns of acute bacterial meningitis throughout a 32-year period. BMC Infect. Dis. 7 : 101.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top
Download PDF
Citation Tools
Comparison of Bacterial Antigen Test and Gram Stain for Detecting Classic Meningitis Bacteria in Cerebrospinal Fluid
Tess Karre, Emily A. Vetter, Jayawant N. Mandrekar, Robin Patel
Journal of Clinical Microbiology Mar 2010, 48 (4) 1504-1505; DOI: 10.1128/JCM.00153-10

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Print

Alerts
Sign In to Email Alerts with your Email Address
Email

Thank you for sharing this Journal of Clinical Microbiology article.

NOTE: We request your email address only to inform the recipient that it was you who recommended this article, and that it is not junk mail. We do not retain these email addresses.

Enter multiple addresses on separate lines or separate them with commas.
Comparison of Bacterial Antigen Test and Gram Stain for Detecting Classic Meningitis Bacteria in Cerebrospinal Fluid
(Your Name) has forwarded a page to you from Journal of Clinical Microbiology
(Your Name) thought you would be interested in this article in Journal of Clinical Microbiology.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Share
Comparison of Bacterial Antigen Test and Gram Stain for Detecting Classic Meningitis Bacteria in Cerebrospinal Fluid
Tess Karre, Emily A. Vetter, Jayawant N. Mandrekar, Robin Patel
Journal of Clinical Microbiology Mar 2010, 48 (4) 1504-1505; DOI: 10.1128/JCM.00153-10
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Top
  • Article
    • ACKNOWLEDGMENTS
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • PDF

KEYWORDS

Antigens, Bacterial
bacteria
bacteriological techniques
cerebrospinal fluid
Meningitis, Bacterial

Related Articles

Cited By...

About

  • About JCM
  • Editor in Chief
  • Board of Editors
  • Editor Conflicts of Interest
  • For Reviewers
  • For the Media
  • For Librarians
  • For Advertisers
  • Alerts
  • RSS
  • FAQ
  • Permissions
  • Journal Announcements

Authors

  • ASM Author Center
  • Submit a Manuscript
  • Article Types
  • Resources for Clinical Microbiologists
  • Ethics
  • Contact Us

Follow #JClinMicro

@ASMicrobiology

       

ASM Journals

ASM journals are the most prominent publications in the field, delivering up-to-date and authoritative coverage of both basic and clinical microbiology.

About ASM | Contact Us | Press Room

 

ASM is a member of

Scientific Society Publisher Alliance

 

American Society for Microbiology
1752 N St. NW
Washington, DC 20036
Phone: (202) 737-3600

 

Copyright © 2021 American Society for Microbiology | Privacy Policy | Website feedback

Print ISSN: 0095-1137; Online ISSN: 1098-660X