FilmArray® meningitis/encephalitis (ME) panel, a rapid molecular platform for diagnosis of CNS infections in a tertiary care hospital in North India: one-and-half-year review
Acute meningitis and encephalitis (AME) is a syndrome of central nervous system (CNS) infections, which could lead to neurological damage and fatality. This study evaluates the multiplex FilmArray® ME Panel which is aimed to diagnose agents causing suspect CNS infections in north India.
A total number of 969 cerebrospinal fluid (CSF) samples collected between August 2016 and January 2018 from patients who showed clinical symptoms of CNS infections were analyzed using the FilmArray® ME Panel. Also a comparison of molecular diagnosis and various laboratory and radiological findings for Streptococcus pneumoniae, Enterovirus and Cryptococcus neoformans positive cases was done.
Out of the 969 CSF samples, 101 cases were found to be positive for viral (n = 55), bacterial (n = 38), fungal (n = 7), and poly-microbial (n = 1) agents. Out of the 55 viral positive cases, the most detected pathogen was Enterovirus (n = 23) with predominance in the age group of 2–17 years, followed by Varicella Zoster virus (n = 14) and HSV1(n = 9) cases. Streptococcus pneumoniae (n = 26) was found to be the predominant bacterial pathogen, of which 17 were detected in the age group above 35 years. Cryptococcus neoformans was found in 7 cases.
The FilmArray® ME Panel aids in rapid detection of 14 pathogens directly from CSF. When compared to gram stain, culture, antigen detection, and CSF biochemical analysis, the FilmArray® ME Panel has detected more cases, some of which are difficult to diagnose by conventional methods. This rapid technology will help the clinicians in case of early patient management, outcomes and provide aid in antimicrobial stewardship.
KeywordsMeningitis Encephalitis FilmArray Streptococcus pneumonia Enterovirus
The authors thankfully acknowledge Alex van Belkum, Global Director of R&D Microbiology, bioMerieux and Richard Gonzalez, Medical Advisor – ASPAC, bioMerieux, for his helpful comments during the preparation of the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
Ethical approval from institute
- 2.Thigpen MC, Whitney CG, Messonnier NE, Zell ER, Lynfield R, Hadler JL, Harrison LH, Farley MM, Reingold A, Bennett NM, Craig AS, Schaffner W, Thomas A, Lewis MM, Scallan E, Schuchat A (2011) Bacterial meningitis in the United States, 1998–2007. N Engl J Med 364:2016–2025. https://doi.org/10.1056/NEJMoa1005384 CrossRefPubMedGoogle Scholar
- 6.Bohr V, Rasmussen N, Hansen B, Kjersem H, Jessen O, Johnsen N, Kristensen HS (1983) 875 cases of bacterial meningitis: diagnostic procedures and the impact of preadmission antibiotic therapy. Part III of a three-part series. J Inf Secur 7:193–202Google Scholar
- 7.Nigrovic LE, Malley R, Macias CG, Kanegaye JT, Moro-Sutherland DM, Schremmer RD, Schwab SH, Agrawal D, Mansour KM, Bennett JE, Katsogridakis YL, Mohseni MM, Bulloch B, Steele DW, Kaplan RL, Herman MI, Bandyopadhyay S, Dayan P, Truong UT, Wang VJ, Bonsu BK, Chapman JL, Kuppermann N (2008) Effect of antibiotic retreatment on cerebrospinal fluid profiles of children with bacterial meningitis. Pediatrics 122:726–730. https://doi.org/10.1542/peds.2007-3275 CrossRefPubMedGoogle Scholar
- 8.Gutierrez M, Emmanuel PJ (2018) Expanding molecular diagnostics for central nervous system infections. Adv Pediatr Infect Dis 65(1):209–227Google Scholar
- 9.Ramanan P, Bryson AL, Binnicker MJ, Pritt BS, Patel R (2017) Syndromic panel-based testing in clinical microbiology. Clin Microbiol Rev 31(1)Google Scholar
- 13.WHO (2012) Establishing surveillance for acute meningitis and encephalitis syndromes through expansion of poliomyelitis and measles surveillance networks in Bangladesh, China and India, 2006–2008. Wkly Epidemiol Rec 87:513–519Google Scholar
- 14.Directorate of National Vector Borne Diseases Control Programme. Guidelines for surveillance of acute encephalitis syndrome (with special reference to Japanese encephalitis). Available at: http://www.nvbdcp.gov.in/Doc/AES%20guidelines.pdf
- 15.World Health Organization (2008) WHO recommended standards for surveillance of selected vaccine-preventable diseases. The Organization, GenevaGoogle Scholar
- 16.NVBDCP. Details of AES/JE Cases and Deaths from 2008–2014. Available at: http://www.nvbdcp.gov.in/Doc/je-aes-cdfeb14.pdf
- 18.Naccache SN, Lustestica M, Fahit M, Mestas J, Dien BJ (2018) One year in the life of a rapid syndromic panel for meningitis/encephalitis: a pediatric tertiary care facility’s experience. J Clin Microbiol 56(5)Google Scholar
- 20.Marchioni E, Ravaglia S, Montomoli C, Tavazzi E, Minoli L, Baldanti F, Furione M, Alfonsi E, Bergamaschi R, Romani A, Piccolo L, Zardini E, Bastianello S, Pichiecchio A, Ferrante P, Delbue S, Franciotta D, Bono G, Ceroni M (2013) Postinfectious neurologic syndromes: a prospective cohort study. Neurology 80(10):882–889CrossRefGoogle Scholar
- 27.Bhatt GC, Sharma T Clinical profile and outcome of Japanese encephalitis in children admitted with acute encephalitis syndromeGoogle Scholar
- 28.Suri V, Narang U, Bhalla A Viral encephalitis in India: management UpdateGoogle Scholar
- 29.Wu-Chung Shen, Hsiu-Hui Chiu, Kuan-Chih Chow, and Chang-Hai Tsai, MR imaging findings of enteroviral encephalomyelitis: an outbreak in TaiwanGoogle Scholar
- 33.BioFire Diagnostics (2015) FilmArray meningitis/encephalitis (ME) panel instruction booklet RF-Y-ASY-0118. BioFire Diagnostics, Salt Lake CityGoogle Scholar