Enhanced pathogen identification among patients with clinically suspected meningitis

Abstract

Background: Delayed or incorrect treatment of meningitis may result in adverse patient outcomes. However, laboratory testing in resource-limited settings is often limited to conventional diagnostic methods. We explored the utility of syndromic molecular assays for diagnosis.Objectives: We tested cerebrospinal fluid (CSF) specimens collected from patients with clinically suspected meningitis submitted to a tertiary hospital laboratory in January 2021 – May 2021. Primary microbiological analysis (culture, Gram stain and cytochemical analysis) was performed as part of routine testing.Method: Residual CSF specimens were tested using a bacterial triplex real-time polymerase chain reaction (PCR) assay and a syndromic multi-pathogen real-time PCR assay for the detection of up to 18 bacterial and viral pathogens. Pathogen detection was compared between conventional and molecular assays.Results: A potential pathogen was detected in 6% (12/188) and 47% (89/188) of specimens on the triplex and the multi-pathogen assay, respectively. Epstein-Barr virus (49/188; 26%), human herpes virus 7 (22/188; 12%), herpes simplex virus 1 (13/188; 7%) and Streptococcus pneumoniae (10/188; 5%) were the leading pathogens detected on the syndromic multi-pathogen PCR. Further, using the multi-pathogen PCR assay, a potential pathogen was detected in 44% (73/166) of the specimens which were negative following routine testing. Overall, combining routine testing and molecular platforms significantly improved pathogen detection (p 0.001); a potential pathogen was identified in 51% (95/188) of the specimens tested, compared to 12% (22/188) using routine methods alone.Conclusion: The use of molecular tests improved pathogen detection by 39% when paired with routine methods.Contribution: Multi-pathogen molecular testing is useful for rapidly diagnosing meningitis cases.