@article{pittir13872,
          volume = {6},
          number = {6},
           month = {June},
           title = {Incorporation of real-time PCR into routine Public Health Surveillance of Culture Negative Bacterial meningitis in S{\~a}o paulo, Brazil},
          author = {CT Sacchi and LO Fukasawa and MG Gon{\cc}alves and MM Salgado and KA Shutt and TR Carvalhanas and AF Ribeiro and B Kemp and MCO Gorla and RK Albernaz and EGL Marques and A Cruciano and EA Waldman and MCC Brandileone and LH Harrison and  S{\~a}o Paulo RT-PCR Surveillance Project Team},
            year = {2011},
         journal = {PLoS ONE},
             url = {http://d-scholarship-dev.library.pitt.edu/13872/},
        abstract = {Real-time (RT)-PCR increases diagnostic yield for bacterial meningitis and is ideal for incorporation into routine surveillance in a developing country. We validated a multiplex RT-PCR assay for Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae in Brazil. Risk factors for being culture-negative, RT-PCR positive were determined. The sensitivity of RT-PCR in cerebrospinal fluid (CSF) was 100\% (95\% confidence limits, 96.0\%-100\%) for N. meningitidis, 97.8\% (85.5\%-99.9\%) for S. pneumoniae, and 66.7\% (9.4\%-99.2\%) for H. influenzae. Specificity ranged from 98.9\% to 100\%. Addition of RT-PCR to routine microbiologic methods increased the yield for detection of S. pneumoniae, N. meningitidis, and H. influenzae cases by 52\%, 85\%, and 20\%, respectively. The main risk factor for being culture negative and RT-PCR positive was presence of antibiotic in CSF (odds ratio 12.2, 95\% CI 5.9-25.0). RT-PCR using CSF was highly sensitive and specific and substantially added to measures of meningitis disease burden when incorporated into routine public health surveillance in Brazil. {\copyright} 2011 Sacchi et al.}
}