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      Methods for rapid diagnosis of meningitis etiology in adults

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          Abstract

          Infectious meningitis can be caused by viral, bacterial or fungal pathogens. Despite widely available treatments, many types of infectious meningitis are still associated with significant morbidity and mortality. Delay in diagnosis contributes to poor outcomes. Cerebrospinal fluid cultures have been used traditionally but are time intensive and sensitivity is decreased by empiric treatment prior to culture. More rapid techniques such as the cryptococcal lateral flow assay (IMMY), GeneXpert MTB/Rif Ultra (Cepheid) and FilmArray multiplex-PCR (Biofire) are three examples that have drastically changed meningitis diagnostics. This review will discuss a holistic approach to diagnosing bacterial, mycobacterial, viral and fungal meningitis.

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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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            Cryptococcal meningitis: epidemiology, immunology, diagnosis and therapy

            Peter R. Williamson, Joseph Jarvis, Anil Panackal … (2016)
            HIV-associated cryptococcal meningitis is by far the most common cause of adult meningitis in many areas of the world that have high HIV seroprevalence. In most areas in Sub-Saharan Africa, the incidence of cryptococcal meningitis is not decreasing despite availability of antiretroviral therapy, because of
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              MALDI-TOF MS for the diagnosis of infectious diseases.

              Robin Patel (2015)
              First introduced into clinical microbiology laboratories in Europe, MALDI-TOF MS is being rapidly embraced by laboratories around the globe. Although it has multiple applications, its widespread adoption in clinical microbiology relates to its use as an inexpensive, easy, fast, and accurate method for identification of grown bacteria and fungi based on automated analysis of the mass distribution of bacterial proteins.
              Article 0 comments Cited 145 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Biomark Med
                Journal ID (iso-abbrev): Biomark Med
                Journal ID (publisher-id): BMM
                Title: Biomarkers in Medicine
                Publisher: Future Medicine Ltd (London, UK )
                ISSN (Print): 1752-0363
                ISSN (Electronic): 1752-0371
                Publication date (Electronic, pub): 08 April 2020
                Publication date (Print, pub): April 2020
                Publication date PMC-release: 08 April 2020
                Volume: 14
                Issue: 6
                Pages: 459-479
                Affiliations
                [1 ]Department of Medicine, University of Kansas, Kansas City, KS 66160, USA
                [2 ]Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
                [3 ]Division of Infectious Diseases, Department of Medicine, University of Kansas, Kansas City, KS 66160, USA
                Author notes
                [* ]Author for correspondence: nate.bahr@ 123456gmail.com
                Author information
                https://orcid.org/0000-0002-9431-8938
                Article
                DOI: 10.2217/bmm-2019-0333
                PMC ID: 7248681
                PubMed ID: 32270693
                SO-VID: e241bbc0-7651-49a8-a09a-049c0ddaa43f
                Copyright © © 2020 Nathan C Bahr and co-authors.
                License:

                This work is licensed under the Attribution-NonCommercial-NoDerivatives 4.0 Unported License

                History
                Date received : 01 August 2019
                Date accepted : 12 February 2020
                Date: 08 April 2020
                Page count
                Pages: 21
                Categories
                Subject: Review

                Keywords: aseptic meningitis,bacterial meningitis,cryptococcal meningitis,diagnosis,diagnostic testing,tuberculous meningitis
                Data availability:
                Keywords: aseptic meningitis, bacterial meningitis, cryptococcal meningitis, diagnosis, diagnostic testing, tuberculous meningitis

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