“…More than 100 bacterial and viral pathogens are known to cause meningitis, but most microbiology laboratories in resource-poor settings test primarily for bacterial pathogens, namely, Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, and group B S treptococcus , using culture, directed PCR, and/or serology (5, 7). In a World Health Organization (WHO)-supported meningitis surveillance study in Dhaka, Bangladesh (8), we collected 23,140 cerebrospinal fluid (CSF) samples from patients with suspected meningitis between 2004 and 2016, 8,125 of which contained ≥10 white blood cells (WBC)/μl. We were able to detect a bacterial etiology in only 1,585 (20%) of these cases despite the use of multiple diagnostic tools, including culture, antigen, and pathogen-specific qPCR assays.…”