Enhancing pathogen identification in patients with meningitis and a negative Gram stain using the BioFire FilmArray® Meningitis/Encephalitis panel

Wootton, Susan H.; Aguilera, Elizabeth; Salazar, Lucrecia; Hemmert, Andrew; Hasbun, Rodrigo

doi:10.1186/s12941-016-0137-1

Cited by 61 publications

(50 citation statements)

References 19 publications

(21 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study also confirms recent findings that viral meningitis can present with neutrophilic pleocytosis that is more common in children with enterovirus infection [16]. Identifying viral causes with a rapid PCR test could potentially avoid or decrease the length of stay in the majority of cases [17]. Overall, we found that the original definition of aseptic meningitis still holds true as does the assertion that patients afflicted with this disease process have generally good outcomes, aside from possible neuropsychological sequelae, despite the diagnostic and treatment choices done by clinicians.…”

Section: Discussionsupporting

confidence: 90%

Aseptic meningitis in adults and children: Diagnostic and management challenges

Shukla

Aguilera

Salazar

et al. 2017

Journal of Clinical Virology

Self Cite

104

View full text Add to dashboard Cite

Background Aseptic meningitis represents a common diagnostic and management dilemma to clinicians. Objectives To compare the clinical epidemiology, diagnostic evaluations, management, and outcomes between adults and children with aseptic meningitis. Study Design We conducted a retrospective study from January 2005 through September 2010 at 9 Memorial Hermann Hospitals in Houston, TX. Patients age ≥ 2 months who presented with community-acquired aseptic meningitis with a CSF white blood cell count >5 cells/mm3 and a negative Gram stain and cultures were enrolled. Patients with a positive cryptococcal antigen, positive blood cultures, intracranial masses, brain abscesses, or encephalitis were excluded. Results A total of 509 patients were included; 404 were adults and 105 were children. Adults were most likely to be female, Caucasian, immunosuppressed, have meningeal symptoms (headache, nausea, stiff neck, photophobia) and have a higher CSF protein (P<0.05). In contrast, children were more likely to have respiratory symptoms, fever, and leukocytosis (P<0.05). In 410 (81%) patients, the etiologies remained unknown. Adults were more likely to be tested for and to have Herpes simplex virus and West Nile virus while children were more likely to be tested for and to have Enterovirus (P<0.001). The majority of patients were admitted (96.5%) with children receiving antibiotic therapy more frequently (P<0.001) and adults receiving more antiviral therapy (P=0.001). A total of 384 patients (75%) underwent head CT scans and 125 (25%) MRI scans; all were normal except for meningeal enhancement. All patients had a good clinical outcome at discharge. Discussion Aseptic meningitis in adults and children represent a management challenge as etiologies remained unknown for the majority of patients due to underutilization of currently available diagnostic techniques.

show abstract

Section: Discussionsupporting

confidence: 90%

Aseptic meningitis in adults and children: Diagnostic and management challenges

Shukla

Aguilera

Salazar

et al. 2017

Journal of Clinical Virology

Self Cite

104

View full text Add to dashboard Cite

show abstract

“…While the RT-PCR assays included in the study had limited coverage compared to some of the commercial assays, it is likely that these assays have the potential to identify the majority of meningitis cases at a much lower cost [19] [18]. Although currently RT-PCR assays are typically performed in large centralised laboratories, future developments in point of care testing may facilitate the devolution of testing to smaller hospitals.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the development of multiplex RT-PCR assays provides the opportunity to detect multiple potential pathogens simultaneously[11–18]. Such multiplex RT-PCR assays can offer a very comprehensive panel of potential pathogens allowing for an extensive and exhaustive investigation of patients with suspected meningitis[19, 20]. However, in practice in specific geographic settings and in particular patient population groups, a far more limited number of pathogens constitute the vast majority of cases of meningitis.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Diagnostic accuracy of two multiplex real-time polymerase chain reaction assays for the diagnosis of meningitis in children in a resource-limited setting

et al. 2017

View full text Add to dashboard Cite

IntroductionAccurate etiological diagnosis of meningitis is important, but difficult in resource-limited settings due to prior administration of antibiotics and lack of viral diagnostics. We aimed to develop and validate 2 real-time multiplex PCR (RT-PCR) assays for the detection of common causes of community-acquired bacterial and viral meningitis in South African children.MethodsWe developed 2 multiplex RT- PCRs for detection of S. pneumoniae, N. meningitidis, H. influenzae, enteroviruses, mumps virus and herpes simplex virus. We tested residual CSF samples from children presenting to a local paediatric hospital over a one-year period, whose CSF showed an abnormal cell count. Results were compared with routine diagnostic tests and the final discharge diagnosis. We calculated accuracy of the bacterial RT-PCR assay compared to CSF culture and using World Health Organisation definitions of laboratory-confirmed bacterial meningitis.ResultsFrom 292 samples, bacterial DNA was detected in 12 (4.1%) and viral nucleic acids in 94 (32%). Compared to CSF culture, the sensitivity and specificity of the bacterial RT-PCR was 100% and 97.2% with complete agreement in organism identification. None of the cases positive by viral RT-PCR had a bacterial cause confirmed on CSF culture. Only 9/90 (10%) of patients diagnosed clinically as bacterial meningitis or partially treated bacterial meningitis tested positive with the bacterial RT-PCR.DiscussionIn this population the use of 2 multiplex RT-PCRs targeting 6 common pathogens gave promising results. If introduced into routine diagnostic testing, these multiplex RT-PCR assays would supplement other diagnostic tests, and have the potential to limit unnecessary antibiotic therapy and hospitalisation.

show abstract

“…The integrated FilmArray system has a turnaround time of about an hour, with only 2 minutes of hands-on time. At the time of the manuscript preparation, two studies have reported on the performance of this assay 79, 80 . Using 48 samples from gram stain negative CSF samples from suspected cases of meningitis, Wootton et al showed that this system detected more viral pathogens especially EBV.…”

Section: Molecular Methods In Diagnosis Of Cns Infectionsmentioning

confidence: 99%

Laboratory Diagnosis of Central Nervous System Infection

Kaplan

Kamboj

et al. 2016

Curr Infect Dis Rep

View full text Add to dashboard Cite

CNS infections are potentially life threatening if not diagnosed and treated early. The initial clinical presentations of many CNS infections are nonspecific making a definitive etiologic diagnosis challenging. Nucleic acid in vitro amplification-based molecular methods are increasingly being applied for routine microbial detection. These methods are a vast improvement over conventional techniques with the advantage of rapid turnaround and higher sensitivity and specificity. Additionally, molecular methods performed on cerebrospinal fluid samples are considered the new gold standard for diagnosis of CNS infection caused by pathogens which are otherwise difficult to detect. Commercial diagnostic platforms offer various monoplex and multiplex PCR assays for convenient testing of targets that cause similar clinical illness. Pan-omic molecular platforms possess potential for use in this area. Although molecular methods are predicted to be widely used in diagnosing and monitoring CNS infections, results generated by these methods need to be carefully interpreted in combination with clinical findings. This review summarizes the currently available armamentarium of molecular assays for diagnosis of central nervous system infections, their application, and future approaches.

show abstract

Enhancing pathogen identification in patients with meningitis and a negative Gram stain using the BioFire FilmArray® Meningitis/Encephalitis panel

Cited by 61 publications

References 19 publications

Aseptic meningitis in adults and children: Diagnostic and management challenges

Aseptic meningitis in adults and children: Diagnostic and management challenges

Diagnostic accuracy of two multiplex real-time polymerase chain reaction assays for the diagnosis of meningitis in children in a resource-limited setting

Laboratory Diagnosis of Central Nervous System Infection

Contact Info

Product

Resources

About