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VOLUME 26 , ISSUE 1 ( January, 2022 ) > List of Articles

Original Article

Clinical Performance of FilmArray Meningitis/Encephalitis Multiplex Polymerase Chain Reaction Panel in Central Nervous System Infections

Sarath Chandran, Aswathy Sasidharan, Suresh Chandran

Keywords : Acute meningitis, Encephalopathy, Polymerase chain reaction

Citation Information : Chandran S, Sasidharan A, Chandran S. Clinical Performance of FilmArray Meningitis/Encephalitis Multiplex Polymerase Chain Reaction Panel in Central Nervous System Infections. Indian J Crit Care Med 2022; 26 (1):67-70.

DOI: 10.5005/jp-journals-10071-24078

License: CC BY-NC 4.0

Published Online: 17-01-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Introduction: Early identification of etiology is very important for initiating appropriate therapy promptly in patients with meningoencephalitis (ME). BioFire FilmArray® meningitis/encephalitis (FA-ME) panel is a fully automated multiplex polymerase chain reaction (PCR) that detects 14 pathogens simultaneously in an hour. There is a dearth of studies highlighting its usefulness in ME syndrome in Indian patients. Materials and methods: We performed a retrospective analysis of patients, admitted to the Kerala Institute of Medical Sciences Hospital, Thiruvananthapuram, Kerala, South India, with meningitis/encephalitis syndrome who underwent the multiplex PCR test on cerebrospinal fluid (CSF) over a period of 2 years from 2016 to 2018. Patients presenting with clinical diagnosis of acute meningitis, encephalitis, or ME who underwent CSF FA-ME panel were studied. The performance of the FA-ME panel was compared to CSF bacterial culture. Results: Two-hundred and fifty-nine patients between December 2016 and December 2018 underwent the FA-ME test in CSF. FA-ME test detected pathogens in 61 (23.6%) out of 259 patients with ME syndrome. Among the pathogens detected by FA-ME panel, enterovirus was the commonest accounting for 29 cases (47.5%), followed by varicella in 11 patients (18%) and pneumococci in 9 (14.8%). CSF bacterial culture yield was low, positive only in 8 (3%) out of 259 cases, and matched with FA-ME panel in only one sample that grew Streptococcus pneumoniae. Bacterial culture yielded seven pathogens in those whose FA-ME panels were negative. Conclusion: FA-ME panel improves diagnostic yield as compared to bacterial culture (26.3 vs 3%). FA-ME test helps in the early initiation of targeted antibiotic therapy and greater antibiotic de-escalation.


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  1. World Health Organization. Neurological disorders: public health challenges. Geneva: World Health Organization; 2006. p. 97–102.
  2. Bennet JE, Blaser MJ, Dolin R, editors. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 8th ed. Canada: Saunders; 2015. p. 1097–1163.
  3. Wootton SH, Aguilera E, Salazar L, Hemmert AC, Hasbun R. Enhancing pathogen identification in patients with meningitis and a negative Gram's stain using the BioFire FilmArray® Meningitis/Encephalitis panel. Ann Clin Microbiol Antimicrob 2016;15(1):26. DOI: 10.1186/s12941-016-0137-1.
  4. Poritz MA, Blaschke AJ, Byington CL, Meyers L, Nilsson K, Jones DE, et al. FilmArray, an automated nested multiplex PCR system for multi-pathogen detection: development and application to respiratory tract infection. PLoS One 2011;6(10):e26047. DOI: 10.1371/journal.pone.0026047.
  5. Buss SN, Leber A, Chapin K, Fey PD, Bankowski MJ, Jones MK, et al. Multicenter evaluation of the BioFire FilmArray gastrointestinal panel for etiologic diagnosis of infectious gastroenteritis. J Clin Microbiol 2015;53(3):915–925. DOI: 10.1128/JCM.02674-14.
  6. Blaschke AJ, Heyrend C, Byington CL, Fisher MA, Barker E, Garrone NF, et al. Rapid identification of pathogens from positive blood cultures by multiplex polymerase chain reaction using the FilmArray system. Diagn Microbiol Infect Dis 2012;74(4):349–355. DOI: 10.1016/j.diagmicrobio.2012.08.013.
  7. Tunkel AR, Glaser CA, Bloch KC, Sejvar JJ, Marra CM, Roos KL, et al. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2008;47(3): 303–327. DOI: 10.1086/589747.
  8. Tzanakaki G, Tsopanomichalou M, Kesanopoulos K, Matzourani R, Sioumala M, Tabaki A, et al. Simultaneous single-tube PCR assay for the detection of Neisseria meningitidis, Haemophilus influenzae type b and Streptococcus pneumoniae. Clin Microbiol Infect 2005;11(5): 386–390. DOI: 10.1111/j.1469-0691.2005.01109.x.
  9. Nesher L, Hadi CM, Salazar L, Wootton SH, Garey KW, Lasco T, et al. Epidemiology of meningitis with a negative CSF Gram's stain: under-utilization of available diagnostic tests. Epidemiol Infect 2016;144(1):189–197. DOI: 10.1017/S0950268815000850.
  10. Javali M, Acharya P, Mehta A, John AA, Mahale R, Srinivasa R. Use of multiplex PCR based molecular diagnostics in diagnosis of suspected CNS infections in tertiary care setting—a retrospective study. Clin Neurol Neurosurg 2017;161:110–116. DOI: 10.1016/j.clineuro.2017.08.013.
  11. Ramalingam RK, Chakraborty D. Retrospective analysis of multiplex polymerase chain reaction-based molecular diagnostics (SES) in 70 patients with suspected central nervous system infections: a single-center study. Ann Indian Acad Neurol 2016;19(4):482. DOI: 10.4103/0972-2327.192483.
  12. Pons-Salort M, Oberste MS, Pallansch MA, Abedi GR, Takahashi S, Grenfell BT, et al. The seasonality of nonpolio enteroviruses in the United States: patterns and drivers. Proc Natl Acad Sci USA 2018;115(12):3078–3083. DOI: 10.1073/pnas.1721159115.
  13. MacVane SH, Nolte FS. Benefits of adding a rapid PCR-based blood culture identification panel to an established antimicrobial stewardship program. J Clin Microbiol 2016;54(10):2455–2463. DOI: 10.1128/JCM.00996-16.
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