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      Delayed Diagnosis of Tuberculous Meningitis Misdiagnosed as Herpes Simplex Virus-1 Encephalitis With the FilmArray Syndromic Polymerase Chain Reaction Panel

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          Abstract

          The FilmArray meningitis/encephalitis (ME) panel is a novel syndromic, nucleic acid amplification test for diagnosis of acute meningitis and encephalitis. Emerging data on its performance are concerning for false-positive results. We present a case of tuberculous meningitis misdiagnosed as herpes simplex virus-1 encephalitis with the FilmArray ME panel. Strategies to mitigate erroneous results are discussed.

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          The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America.

          Allan Tunkel, Carol A Glaser, Karen Bloch … (2008)
          Guidelines for the diagnosis and treatment of patients with encephalitis were prepared by an Expert Panel of the Infectious Diseases Society of America. The guidelines are intended for use by health care providers who care for patients with encephalitis. The guideline includes data on the epidemiology, clinical features, diagnosis, and treatment of many viral, bacterial, fungal, protozoal, and helminthic etiologies of encephalitis and provides information on when specific etiologic agents should be considered in individual patients with encephalitis.
          Article 0 comments Cited 247 times – based on 0 reviews     Review now
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            Multicenter Evaluation of BioFire FilmArray Meningitis/Encephalitis Panel for Detection of Bacteria, Viruses, and Yeast in Cerebrospinal Fluid Specimens

            Amy L Leber, Kathy Everhart, Joan-Miquel Balada-Llasat … (2016)
            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 (∼1-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.
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              Multiplexed Molecular Diagnostics for Respiratory, Gastrointestinal, and Central Nervous System Infections

              Kimberly E. Hanson, Marc Roger Couturier (2016)
              Multiplex molecular diagnostic panels represent a paradigm shift for both clinical microbiology and infectious diseases. This review summarizes the advantages and limitations of current US Food and Drug Administration–approved tests for respiratory viruses, diarrheal illness, and meningitis/encephalitis.
              Article 0 comments Cited 36 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Forum Infect Dis
                Journal ID (iso-abbrev): Open Forum Infect Dis
                Journal ID (publisher-id): ofids
                Title: Open Forum Infectious Diseases
                Publisher: Oxford University Press (US )
                ISSN (Electronic): 2328-8957
                Publication date Collection: Winter 2017
                Publication date (Electronic): 07 December 2016
                Publication date PMC-release: 07 December 2016
                Volume: 4
                Issue: 1
                Electronic Location Identifier: ofw245
                Affiliations
                [1 ]Division of Infectious Diseases and Geographic Medicine, Department of Medicine ,
                [2 ]Department of Pathology , and
                [3 ]Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford University School of Medicine , California;
                [4 ]Clinical Microbiology Laboratory, Stanford University Medical Center , Palo Alto, California
                Author notes

                Correspondence: N. Banaei, MD, Stanford Health Care, Clinical Microbiology Laboratory, 3375 Hillview Ave, Rm. 1602, Palo Alto, CA 94304 ( nbanaei@ 123456stanford.edu ).

                Article
                Publisher ID: ofw245
                DOI: 10.1093/ofid/ofw245
                PMC ID: 5437853
                PubMed ID: 28540320
                SO-VID: 467dea50-5267-42de-8d17-84225aaea1e1
                Copyright © © The Author 2016. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Date received : 19 September 2016
                Date accepted : 17 November 2016
                Page count
                Pages: 4
                Categories
                Subject: Brief Report
                Subject: Editor's Choice

                Keywords: encephalitis,filmarray panel,meningitis,molecular diagnostics,syndromic panel.
                Data availability:
                Keywords: encephalitis, filmarray panel, meningitis, molecular diagnostics, syndromic panel.

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