Retrospective evaluation of multiplex PCR panel results from CSF samples in a university hospital

Abstract

Aim: Given the significant mortality and sequelae due to meningitis, rapid diagnosis and initiation of treatment have a major impact on patient outcomes. In many cases of meningitis/meningoencephalitis, empirical treatment should be initiated immediately. This empirical treatment regimen is initiated based on the cumulative antibiotic susceptibility results in the region. The aim of our study was to retrospectively determine the causative agents in cerebrospinal fluid samples of patients who received a presumptive diagnosis of meningitis, using Multiplex Polymerase Chain Reaction (PCR) tests. Materials and Methods: The study included 206 cerebrospinal fluid samples from different patients with a preliminary diagnosis of meningitis sent from various clinics. The Biospeedy viral nucleic acid isolation kit (Bioeksen, Türkiye) was used for the isolation of genetic material. Genetic materials (DNA/RNA) related to Herpes simplex virus 1-2, Humman herpesvirus 6-7-8, Varicella zoster virus, Enterovirus, Cytomegalovirus, Human Parechoviruses, Haemophilus influenzae, Listeria monocytogenes, Streptococcus pneumoniae, Neisseria meningitidis, Streptococcus agalactiae, Escherichia coli K1, Cryptococcus gattii/neoformans in cerebrospinal fluid samples were investigated using the Meningitis/Encephalitis RT-qPCR MX-17 Panel (RT-qPCR MX-17S Panel, Bio-Speedy®, Bioeksen, Türkiye) multiplex PCR kit. Results: According to the PCR results, the causative agent was identified in a total of 19 patients. Nine patients were found to have Streptococcus pneumoniae, two had Varicella zoster virus, and two had Enterovirus. Additionally, six patients had separate detections of Haemophilus influenzae, Cytomegalovirus, Herpes simplex virus 1, Human herpesvirus 6, Human herpesvirus 8, and Parechoviruses. Conclusion: Recently, simple and rapid molecular tests such as PCR have contributed to an increase in the early detection of causative agents. Based on the performance of diagnostic tests, we propose an algorithm for the use of both syndromic and specific tests in patients at risk for meningitis/encephalitis.

Keywords

• cerebrospinal fluid
• meningitis
• multiplex PCR