Cerebrospinal fluid analysis in emergency patients with suspected infection of the central nervous system

Abstract

Background and purpose Meningitis and encephalitis are potentially life‐threatening diseases that require fast and accurate diagnostics and therapy. The value of polymerase chain reaction (PCR) multiplex testing in clinical practice is still a matter of debate. This study aims to evaluate its benefits and limitations in emergency patients. Methods We assessed the value of a meningoencephalitis PCR array in the clinical routine of an emergency department. Results Of 1578 emergency patients who received a lumbar puncture, 43% received it for a clinically suspected central nervous system (CNS) infection. After initial workup for cerebrospinal fluid (CSF) cell count, protein and glucose, a CNS infection was still considered likely in 307 patients. In these patients, further microbiologic workup was performed. A total of 230 samples were examined by PCR and a pathogen was detected in 66 of these samples. In the case of a positive microbiologic result, a comparison between PCR array and standard method was available for 59 samples, which demonstrated an overcall agreement of 80% (n = 47/59). Of interest, exclusively array‐positive results were observed for patients with meningitis found to be positive for Streptococcus pneumoniae; four out of five patients had been treated with antibiotics before the lumbar puncture. In samples with normal CSF cell count only two positive array results were obtained, both for human herpesvirus 6, and these were not clinically relevant. Conclusion Our data suggest that the array substantially contributes to a detection of pathogens in patients with suspected CNS infection and seems of particular interest in patients with acute bacterial meningitis under empiric antibiotic treatment. In CSF samples with normal cell count, it might be dispensable.

Severe meningoencephalitis: epidemiology and outcomes

“…A recent study suggests that a systematic CSF WBC count threshold of more than 10 cells/μl should be used to systematically perform multiplex PCR [7 ▪ ]. In contrast, it may be unnecessary in CSF samples with normal cell counts [8 ▪ ]. Of note, a recent study reminded the limits of FA-ME performance with false-positive results (one for S. pneumoniae , and one HSV-2) and false-negative results (2 enterovirus, 1 VZV, 2 CMV, 2 HSV-1, and 1 E .…”