Introduction:

meningoencephalitis (ME) is a serious disease that can be life-threatening and cause long-term sequelae. Typically, the etiological diagnosis of ME is based on direct examination, culture, and more recently, the detection of soluble antigens in cerebrospinal fluid (CSF) and the molecular detection of viral agents. In 2015, the FDA approved the first multiplex PCR assay for the simultaneous detection of viruses, bacteria, and parasites associated with community-acquired ME and ME in immunocompromised patients, with an approximate turnaround time of 1 hour.

Objectives:

describe the agents detected by real-time PCR in the population assisted at a reference pediatric hospital. Compare the performance of direct examination and CSF culture versus molecular detection with the ME panel. Analyze the predictive value of the CSF cytochemical study.

Methodology:

observational, descriptive study. We included all children assisted at a reference pediatric hospital from whom a CSF sample was sent to the microbiology laboratory for bacteriological and/or virological study. CSF samples were analyzed by direct examination, culture, and nucleic acid detection with the BioFire FilmArray ME panel (Biomerieux) or QIAstat-Dx (Qiagen), regardless of the cytochemical study result. The results were analyzed retrospectively by reviewing laboratory databases. Period: January 2016 - June 2024. Qualitative variables are expressed as absolute and relative percentage frequencies.

Results:

834 CSF samples were processed: 155 (18.6%) were positive with the ME panel, and 19 (2.3%) were invalid. Viral agents were detected in 60% of the positive samples, bacterial agents in 37.5%, and yeasts in 2.5%. More than one agent was detected in 3.9% of the samples. The most frequent viruses were human herpesvirus 6 (47) and enterovirus (32). The most frequent bacterium was Neisseria meningitidis (31), followed by Haemophilus influenzae (13) and Streptococcus agalactiae (8). Of the samples with molecular detection of bacteria: CSF culture was positive in 48.3%, and blood culture recovered 6.7% of additional agents; bacteria were observed in the direct examination in 43.3%, and 94.7% had a typical profile of acute bacterial meningitis in the cytochemical study. In contrast, of the samples with viral detection, only 22.6% had altered CSF cytochemistry.

Conclusions:

human herpesvirus 6, enterovirus, and N. meningitidis were the most frequently detected pathogens. However, the detection of human herpesvirus 6 does not always indicate an active infection and may correspond to a latent infection. Therefore, it is crucial to interpret PCR results within the patient’s clinical environment. Bacterial etiological diagnosis using the ME panel doubled the recovery of culture. Given that meningococcal meningitis is a vaccine-preventable disease, universal immunization would significantly improve the current epidemiological situation.

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