Counterimmunoelectrophoresis in the diagnosis of bacterial meningitis

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Abstract
This study investigated whether counterimmunoelectrophoresis (CIE) would facilitate the rapid, etiological diagnosis of bacterial meningitis when used in parallel with other routine methods in a medical bacteriological laboratory. Of 3674 consecutive CSF specimens received at the Department of Diagnostic Bacteriology, Statens Seruminstitut [Copenhagen, Denmark], 283 specimens (each representing 1 patient) were selected for examination by CIE on the basis of bacteria, pleocytosis or both by microscopy, or positive culture or both. CIE was performed with [rabbit] antisera to Neisseria meningitidis (groups A, B and C), Streptococcus pneumoniae (omniserum and pools A-I) and Haemophilus influenzae type b. Antigen was detected in 57% (72/126) of specimens in which cultures revealed these 3 kinds of microorganisms in CSF and in 12% (17/139) of the culture-negative specimens. CSF specimens from 21 patients with bacterial meningitis caused by other species were all negative in CIE, except 4, 3 of which contained Escherichia coli antigen reacting with antiserum to N. meningitidis group B and 1 E. coli antigen reacting with antiserum to H. influenzae type b. Specific diagnosis was achieved in 60% (170/283) of the specimens studied and could be established within 1 h in 85% (145/170) by the combined results of microscopy and CIE. Ten specimens, 9 of which showed a reaction with antiserum to N. meningitidis group A, were positive by CIE only.