How appropriate are cerebrospinal fluid polymerase chain reaction requests for suspected central nervous system infections?

Abstract

-Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) assays have become the main diagnostic tests for central nervous system viral infections in recent years. Previous studies have suggested algorithms based on CSF leukocyte count and total protein levels to determine when CSF PCR assays are indicated. Based on these criteria, 1,469 CSF PCR tests requested over a two-year period were reviewed. A proportion of positive PCR results were found in children with normal CSF, unlike in adults where such occurrences were extremely rare. The results suggest that applying a strategy of screening CSF specimens using leukocyte count, glucose and protein, at least in adults, may have avoided more than half of CSF PCR requests with little detriment to patient care and considerable cost savings. Larger prospective studies are needed to determine whether algorithms using standard CSF parameters and clinical information can optimise the use of CSF PCR assays in clinical practice.

PCR-based approach for qualitative molecular analysis of six neurotropic pathogens

“…PCR-based protocols have been included in a number of guidelines for the management of patients with CNS infectious diseases. For instance, PCR approaches represent the gold standard to detect meningitis, encephalitis caused by a variety of viruses, HSV encephalitis, HV and JC in CSF Mamoojee and Chadwick, 2011) and viruses in brain biopsies for the diagnosis of progressive multifocal leukoencephalopathy (Lindquist et al, 1988;Webet et al, 1994;Lakeman and Whitley 1995;Tang et al, 1999;Boivin, 2004;Mamoojee and Chadwick, 2011).…”