Abstract
Background: Central nervous system (CNS) infection is associated with high rates of morbidity and mortality, and despite advancements in molecular testing, aseptic meningitis remains challenging to diagnose. Aseptic meningitis cases are often underreported worldwide, which impacts the quality of patient care. Therefore, we aimed to assess the results of BioFire® FilmArray® meningitis/encephalitis (ME) PCR panel, clinical characteristics, and etiologies of aseptic meningitis patients.Methods: From January 2018 to January 2020, all pediatric and adult patients in a large tertiary medical center who underwent lumbar puncture and cerebrospinal fluid (CSF) testing by a ME multiplex PCR panel and who fit the aseptic meningitis definition were retrospectively reviewed.Results: Data were reviewed from 1,607 patients; 240 met the inclusion criteria (54.6% males; 68.8% <4 years of age). The rate of detected viral causes of aseptic meningitis was 40.4%; therefore, 59.6% of the patients remained with unidentified etiology. Among the identified viral meningitis, enterovirus and human herpesvirus 6 (HHV-6) were the most common (25 and 7.9%, respectively). The median length of hospital stay was 6 days, and it was longer in patients with unidentifiable aseptic meningitis (p < 0.0001).Conclusion: Aseptic meningitis is common among suspected meningitis patients, but most cases remained of unknown etiology. The most common identified viruses were enterovirus followed by HHV-6, and there is predominance in males and the pediatric age group. These results highlight that further research is needed to identify other etiologies and possible additional viral pathogens for aseptic meningitis in the current diagnostic methods.
Highlights
Central nervous system (CNS) infections—whether by bacteria, fungi, protozoa, or viruses— are neurological emergencies requiring urgent medical intervention [1,2,3]
None of the Intensive care unit (ICU) cases were diagnosed with encephalitis
Death was reported in three viral meningitis patients, all of whom were immunocompromised patients
Summary
Central nervous system (CNS) infections—whether by bacteria, fungi, protozoa, or viruses— are neurological emergencies requiring urgent medical intervention [1,2,3]. CNS infections are diagnosed as meningitis, encephalitis, and meningoencephalitis, depending on the presence of meningeal signs, focal signs, and altered brain functions, respectively [4]. The diagnosis of meningitis is clinically challenging; polymerase chain reaction (PCR) testing helps distinguish between viral, bacterial, and fungal meningitis [5, 12]. Using PCR, several international studies reported more viral than bacterial or fungal meningitis cases [13,14,15]. Central nervous system (CNS) infection is associated with high rates of morbidity and mortality, and despite advancements in molecular testing, aseptic meningitis remains challenging to diagnose. We aimed to assess the results of BioFire® FilmArray® meningitis/encephalitis (ME) PCR panel, clinical characteristics, and etiologies of aseptic meningitis patients
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