Over a million people each year, most of them in the "meningitis belt" in Africa, contract bacterial meningitis, a potentially deadly infection of tissues that line the brain and spinal cord. The disease can be caused by several kinds of bacteria, and identifying the culprit early during an outbreak is critical to its containment. Suzanne Chanteau and colleagues in Niger have now developed a new series of simple and accurate tests that can determine the cause of an outbreak locally. As they describe in a research article in the international open-access medical journal PLoS Medicine, their "dipstick" tests require no fancy laboratory equipment, and not even refrigeration.

The tests, done on the patient's spinal fluid (which is obtained as a part of the routine evaluation of someone suspected of having meningitis) can determine whether the disease is caused by one of the four most common groups of meningococcus circulating in Africa. Two paper strips, the "dipsticks", are placed in two separate tubes of the patient's spinal fluid. After several minutes, the appearance of red lines on the dipsticks shows whether one of the four groups of meningococcus is present, and if so, which one.

The new dipstick test for meningococcal meningitis represents a major advance for health-care workers in remote locations affected by meningitis epidemics. This test can be stored without refrigeration and used at bedside in the hot temperatures typical of the African savannah during the meningitis season. The dipsticks are easier to use than currently available test kits, give more rapid results, and are more accurate. They promise to be an important tool for guiding individual treatment decisions as well as public health actions, including vaccine selection, against the perennial threat of epidemic meningitis.