Clinical Usefulness of a Multiplex Molecular Panel for Central Nervous System Infection: An 11-Month Experience at a Tertiary Center in Korea

Abstract

Purpose The purpose of our study was to evaluate the usefulness of the BiofireFilmArray Meningitis/Encephalitis (FA ME) panel and identify factors associated with positive FA ME panel results. Methods We retrospectively analyzed the medical records of 129 patients (45 children, 84 adults) with central nervous system infections and FA ME panel test results. We compared the results of the FA ME panel and the diagnostic yield between pediatric and adult patients with positive and negative FA ME panel results. Positive FA ME panel results were compared with conventional microbiological testing. Results Forty-three patients (33.3%) had positive results on the FA ME panel. The detected pathogens were enterovirus (n=17, 39.5%), varicella zoster virus (n=10, 23.3%), herpes simplex virus-2 (n=2, 16.3%), herpes simplex virus-1 (n=2, 4.7%), human parechoviruses (n=2), Cryptococcus neoformans/gattii (n=2), Streptococcus agalactiae (n=1, 2.3%), Streptococcus pneumoniae (n=1), and Haemophilus influenzae (n=1). The time to detection of the FA ME panel (4.9±6.6 hours) was significantly shorter than that of conventional culture (77.4±48.2 hours) (P=0.005). Fever was more common in the positive FA ME group than in the negative FA ME group (81.4% vs. 41.9%) and in pediatric patients than in the adult patients (93.3% vs. 34.5%) (P<0.001 for both). The detection rate of the FA ME panel was higher in pediatric patients than in adult patients (55.8% vs. 22.6%, P<0.001). Conclusion The FA ME panel improves the diagnostic rate in patients with suspected central nervous system infections, with potential favorable implications for the quality of management and prognosis.

Keywords

• meningitis
• encephalitis
• polymerase chain reaction
• central nervous system infections
• cerebrospinal fluid