Diagnostic performance of a multiplex PCR assay for meningitis in an HIV-infected population in Uganda

Rhein, Joshua; Bahr, Nathan C; Hemmert, Andrew; Cloud, Joann L.; Bellamkonda, Satya; Oswald, Cody; Lo, Eric; Nabeta, Henry W.; Kiggundu, Reuben; Akampurira, Andrew; Musubire, Abdu K; Williams, Darlisha A; Meya, David B.; Boulware, David R.

doi:10.1016/j.diagmicrobio.2015.11.017

Cited by 96 publications

(66 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It has been shown that cryptococcal antigen can remain positive for long periods of time after therapy, even when culture and smears are negative (40). In a recent study of HIV-infected individuals with cryptococcal meningitis, the relative sensitivity of the FilmArray ME Panel for detection of Cryptococcus in CSF has been demonstrated to be 96% for detection of Ն100 Cryptococcus CFU/ml and also demonstrated that the antigen test may be positive while the FilmArray is negative (41).…”

Section: Discussionmentioning

confidence: 99%

Multicenter Evaluation of BioFire FilmArray Meningitis/Encephalitis Panel for Detection of Bacteria, Viruses, and Yeast in Cerebrospinal Fluid Specimens

et al. 2016

Self Cite

View full text Add to dashboard Cite

Rapid diagnosis and treatment of infectious meningitis and encephalitis are critical to minimize morbidity and mortality. Comprehensive testing of cerebrospinal fluid (CSF) often includes Gram stain, culture, antigen detection, and molecular methods, paired with chemical and cellular analyses. These methods may lack sensitivity or specificity, can take several days, and require significant volume for complete analysis. The FilmArray Meningitis/Encephalitis (ME) Panel is a multiplexed in vitro diagnostic test for the simultaneous, rapid (ϳ1-h) detection of 14 pathogens directly from CSF specimens: Escherichia coli K1, Haemophilus influenzae, Listeria monocytogenes, Neisseria meningitidis, Streptococcus pneumoniae, Streptococcus agalactiae, cytomegalovirus, enterovirus, herpes simplex virus 1 and 2, human herpesvirus 6, human parechovirus, varicella-zoster virus, and Cryptococcus neoformans/Cryptococcus gattii. We describe a multicenter evaluation of 1,560 prospectively collected CSF specimens with performance compared to culture (bacterial analytes) and PCR (all other analytes). The FilmArray ME Panel demonstrated a sensitivity or positive percentage of agreement of 100% for 9 of 14 analytes. Enterovirus and human herpesvirus type 6 had agreements of 95.7% and 85.7%, and L. monocytogenes and N. meningitidis were not observed in the study. For S. agalactiae, there was a single false-positive and false-negative result each, for a sensitivity and specificity of 0 and 99.9%, respectively. The specificity or negative percentage of agreement was 99.2% or greater for all other analytes. The FilmArray ME Panel is a sensitive and specific test to aid in diagnosis of ME. With use of this comprehensive and rapid test, improved patient outcomes and antimicrobial stewardship are anticipated.

show abstract

Section: Discussionmentioning

confidence: 99%

Multicenter Evaluation of BioFire FilmArray Meningitis/Encephalitis Panel for Detection of Bacteria, Viruses, and Yeast in Cerebrospinal Fluid Specimens

et al. 2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…Additional molecular testing for 14 common meningitis aetiologies did not reveal any other explanatory pathogens in CSF positive for Xpert Ultra only. 18 Furthermore, nextgeneration sequencing was able to independently confirm M tuberculosis DNA when extracted from six stored Ultra-positive cartridges.…”

Section: Discussionmentioning

confidence: 99%

“…First, we retrospectively ran CSF specimens positive only for Xpert Ultra on the FilmArray Meningitis/Encephalitis Panel (BioFire Diagnostics, Salt Lake City, UT, USA), which uses a multiplex PCR to detect nucleic acids of 14 meningitis pathogens of Streptococcus pneumoniae, Neisseria meningitidis, Listeria monocytogenes, Haemophilus influenzae, Streptococcus agalactiae, Escherichia coli, herpes simplex virus types 1 and 2, cytomegalovirus, varicella zoster virus, human herpes virus 6, enterovirus, human parechovirus, and Cryptococcus neoformans/gattii. 18 Second, we used next-generation sequencing to verify the presence of M tuberculosis DNA by an alternative method. For CSF specimens positive for Xpert Ultra, we extracted the residual volume of liquid left in the Xpert Ultra cartridges, which potentially contained DNA amplicons, and deep sequenced it on an Illumina MiniSeq platform (Illumina, San Diego, CA, USA).…”

Section: Implications Of All the Available Evidencementioning

confidence: 99%

Diagnostic accuracy of Xpert MTB/RIF Ultra for tuberculous meningitis in HIV-infected adults: A prospective cohort study

2018

Indian Journal of Tuberculosis

View full text Add to dashboard Cite

show abstract

“…There are benefits to considering a rapid, syndrome-based testing approach to acute pharyngitis, analogous to those that have been implemented for patients with respiratory symptoms, diarrheal illnesses, and meningitis/encephalitis (28)(29)(30)(31). Such a panel might include a broad range of common or especially virulent bacterial and viral causes of acute pharyngitis and may be tailored to specific age groups ( Table 1).…”

Section: Counterpointmentioning

confidence: 99%

Point-Counterpoint: A Nucleic Acid Amplification Test for Streptococcus pyogenes Should Replace Antigen Detection and Culture for Detection of Bacterial Pharyngitis

et al. 2016

View full text Add to dashboard Cite

Nucleic acid amplification tests (NAATs) have frequently been the standard diagnostic approach when specific infectious agents are sought in a clinic specimen. They can be applied for specific agents such as S. pyogenes, or commercial multiplex NAATs for detection of a variety of pathogens in gastrointestinal, bloodstream, and respiratory infections may be used. NAATs are both rapid and sensitive. For many years, S. pyogenes testing algorithms used a rapid and specific group A streptococcal antigen test to screen throat specimens, followed, in some clinical settings, by a throat culture for S. pyogenes to increase the sensitivity of its detection. Now S. pyogenes NAATs are being used with increasing frequency. Given their accuracy, rapidity, and ease of use, should they replace antigen detection and culture for the detection of bacterial pharyngitis? Bobbi Pritt and Robin Patel of the Mayo Clinic, where S. pyogenes NAATs have been used for well over a decade with great success, will explain the advantages of this approach, while Richard (Tom) Thomson and Tom Kirn of the NorthShore University HealthSystem will discuss their concerns about this approach to diagnosing bacterial pharyngitis. POINT Acute pharyngitis is one of the most common diagnoses made in outpatient settings (1). Although viruses are responsible for the majority of cases, Streptococcus pyogenes (beta-hemolytic group A streptococci [GAS]) and, less commonly, other bacteria are estimated to cause 25% of the cases in adults and nearly 40% of the cases in children (2-4). Most cases of GAS pharyngitis are mild and self-limited, although potential complications include peritonsillar abscesses, otitis media, mastoiditis, cervical lymphadenitis, pneumonia, rheumatic fever, and poststreptococcal glomerulonephritis. Antimicrobial therapy may prevent these complications and may also shorten the duration of illness and potentially minimize the spread of infection to others; for these reasons, antibiotics are frequently administered, particularly to children and to adults with severe GAS pharyngitis (5, 6).We acknowledge that implicit in any diagnostic strategy is an assumption that results will be actionable, which, in the case of GAS pharyngitis, means that treatment would be administered. We realize that GAS pharyngitis, especially when it is nonsevere, is not universally treated and that there are geographic practice differences. There are a number of reasons for this, including that antibiotics have a relatively small effect in reducing symptoms and symptom duration, that rheumatic fever and poststreptococcal glomerulonephritis are rare in certain populations, that antibiotics risk disturbing the microbiome (and consequently increasing the risk of conditions such as thrush and Clostridium difficileassociated diarrhea), that antimicrobial use may result in allergies and other adverse drug effects, and also because of the associated cost and logistics of testing and treatment. Despite these controversies, which we will subsequently propose justify an outco...

show abstract

Diagnostic performance of a multiplex PCR assay for meningitis in an HIV-infected population in Uganda

Cited by 96 publications

References 21 publications

Multicenter Evaluation of BioFire FilmArray Meningitis/Encephalitis Panel for Detection of Bacteria, Viruses, and Yeast in Cerebrospinal Fluid Specimens

Multicenter Evaluation of BioFire FilmArray Meningitis/Encephalitis Panel for Detection of Bacteria, Viruses, and Yeast in Cerebrospinal Fluid Specimens

Diagnostic accuracy of Xpert MTB/RIF Ultra for tuberculous meningitis in HIV-infected adults: A prospective cohort study

Point-Counterpoint: A Nucleic Acid Amplification Test for Streptococcus pyogenes Should Replace Antigen Detection and Culture for Detection of Bacterial Pharyngitis

Contact Info

Product

Resources

About