TABLE 1.

Laboratory microbiology workup on peripheral blood and/or CSF for the diagnosis of meningococcal disease as performed at the major hospitals in Northern Ireland

Site	Primary Culture*				Latex	Sens	ID	PCR
AAH	CBA	35 - 37°C	5 - 10% CO2	48Hrs	Wellcogen antigen test	ETest	MALDI-TOF	Manchester (Confirmation, typing and sensitivities)
	Choc	35 - 37°C	5 - 10% CO2	48Hrs	(if adult non blood stained WBC count > 5 /mm3)
					(if neonate non blood stained WBC count >30)
RVH	CBA	34 - 38°C	5 - 10% CO2	48Hrs	Pastorex Meningitis Kit	ETest	MALDI-TOF or Vitek2	Regional Virus Laboratory (RVL) [Confirmation, serogroup type]**
	Choc	34 - 38°C	5 - 10% CO2	48Hrs	(if WBC count abnormal)
CAH	CBA	35.5°C	5 - 10% CO2	48Hrs	None	Etest	API NH	Manchester (Confirmation, typing)
	Choc	35.5°C	5 - 10% CO2	48Hrs				RVL Virology if PCR requested on form
UH	CBA	35 - 37°C	5 - 10% CO2	48Hrs	Pastorex Meningitis Kit	Etest	Vitek2	RVL [Confirmation, serogroup type]
	Choc	35 - 37°C	5 - 10% CO2	48Hrs	(if WBC count > 50 /mm3)

Abbreviations: AAH=Antrim Area Hospital, CAH=Craigavon Area Hospital, RVH = Royal Victoria Hospital, UH=Ulster Hospital, CBA = Columbia Blood Agar, Choc = Chocolate Agar

^*HSC Clinical Microbiology Laboratories in Northern Ireland base their SOPs off the UK Standards for Microbiology Investigations, Investigation of Cerebrospinal Fluid (SMI B27) which is produced in association with several groups including the Northern Ireland Microbiology Forum And Audit Group.

^**Current practice is for qPCR testing (ctrA TaqMan) to be performed in Belfast. Positives are all typed by qPCR (siaD TaqMan) with ctrA LAMP also used for confirmation, especially of “discrepant” results