Utility of cerebrospinal fluid multiplex polymerase chain reaction assay in children suspected of meningitis or encephalitis in a tertiary care hospital in Thailand.

BACKGROUND

The BioFire®FilmArray® meningitis/encephalitis panel (ME panel)identifies 14 cerebrospinal fluid (CSF) pathogens. It has not been studied in Thailand,where the epidemiology of central nervous system (CNS) infection may differ from thatof countries with temperate climates. We conducted a study to evaluate theperformance of the ME panel in Thai children.

METHOD: We conducted a prospective study in children suspected of meningitis orencephalitis at the Queen Sirikit National Institute of Child Health in Bangkok, Thailand.In addition to routine tests, CSF was tested simultaneously with an ME panel.

RESULTS

Seventy-three children diagnosed with meningitis or encephalitis wereenrolled. Of them, 47 (64.4%) had an infectious etiology, 21 (28.8%) a non-infectiousetiology (mainly immune encephalitis), and 5 had an undetermined etiology. Thirtypatients had pathogens confirmed: 11 bacteria, 5 Mycobacterium tuberculosis, 5Arboviruses (Dengue and Chikungunya), 8 herpesviruses, and 2 influenza viruses.One patient had both Chikungunya and Influenza virus. Of them, 13 pathogens (43%)were not covered by the ME panel, including Klebsiella spp., Acinetobacter spp., M. tuberculosis, Dengue, Chikungunya, and Influenza virus. The ME panel provided 59% sensitivity and 95% specificity when excluding these pathogens.

CONCLUSION

The ME panel is a reliable tool for supporting the management of CNSinfections due to its high specificity and rapid turnaround time. However, the diversity ofpathogens that cause CNS diseases poses a challenge to its use in tropical countries.