ME Panel Research Articles

Etiology of Central Nervous System Infections in a Rural Area of Nepal Using Molecular Approaches.

.The etiology of infections of the central nervous system (CNS) in Nepal often remains unrecognized because of underdeveloped laboratory facilities. The aim of this study was to investigate the etiology of CNS infections in a rural area of Nepal using molecular methods. From November 2014 to February 2016, cerebrospinal fluid (CSF) was collected from 176 consecutive patients presenting at United Mission Hospital in Tansen, Nepal, with symptoms of possible CNS infection. After the CSF samples were stored and transported frozen, polymerase chain reaction (PCR) was performed in Sweden, targeting a total of 26 pathogens using the FilmArray® ME panel (BioFire, bioMerieux, Salt Lake City, UT), the MeningoFinder® 2SMART (PathoFinder, Maastricht, The Netherlands), and an in-house PCR test for dengue virus (DENV), Japanese encephalitis virus (JEV), and Nipah virus (NiV). The etiology could be determined in 23%. The bacteria detected were Haemophilus influenzae (n = 5), Streptococcus pneumoniae (n = 4), and Neisseria meningitidis (n = 1). The most common virus was enterovirus detected in eight samples, all during the monsoon season. Other viruses detected were cytomegalovirus (n = 6), varicella zoster virus (n = 5), Epstein–Barr virus (n = 3), herpes simplex virus (HSV) type 1 (HSV-1) (n = 3), HSV-2 (n = 3), human herpes virus (HHV) type 6 (HHV-6) (n = 3), and HHV-7 (n = 2). Cryptococcus neoformans/gatti was found in four samples. None of the samples were positive for DENV, JEV, or NiV. Of the patients, 67% had been exposed to antibiotics before lumbar puncture. In conclusion, the etiology could not be found in 77% of the samples, indicating that the commercial PCR panels used are not suitable in this setting. Future studies on the etiology of CNS infections in Nepal could include metagenomic techniques.

Usefulness of the FilmArray meningitis/encephalitis (M/E) panel for the diagnosis of infectious meningitis and encephalitis in Taiwan.

Early recognition of causative pathogens is critical for the appropriate management of central nervous system infection and improved outcomes. The BioFire® FilmArray® Meningitis/Encephalitis Panel (BioFire® ME Panel, BioFire Diagnostics) is the first U.S. Food and Drug Administration (FDA)-approved multiplex PCR assay that allows the rapid detection of 14 pathogens, including bacteria (n=6), viruses (n=7), and fungi (n=1), from cerebrospinal fluid (CSF). The performance of the panel is expected to be dependent on the epidemiology of M/E in different geographical regions. In this preliminary study, we used the BioFire® ME Panel in 42 subjects who presented to the emergency department with symptoms of M/E in our hospital. The results were compared to conventional culture, antigen detection, PCR, and various laboratory findings. The panel detected six positive samples, of which five were viral and one bacterial. We observed an overall agreement rate of 88% between the BioFire® ME Panel results and the conventional methods. There were no false-positive findings, but five discordant results were observed for enterovirus, herpes simplex virus type 1, Escherichia coli, and Cryptococcus species. The BioFire® ME Panel performed equivalently to the traditional PCR methods for virus detection, and better than bacterial cultures. This revolutionary system represents a paradigm shift in the diagnosis of M/E and may aid in the rapid identification of community-acquired M/E. However, the usefulness of this tool is limited in regions with a high prevalence of infectious M/E caused by microorganisms not included in the panel.

The integration of the molecular methods in the diagnosis algorithm for the poliovirus detection in the sewage water: comparing concentration and detection methods. A Pilot Study.

Two cases of circulating vaccine-derived poliovirus type 1(cVDPV1), from southwestern Ukraine, bordering Romania, were confirmed in 2015 and the environmental enterovirus surveillance was enhanced in our country. The molecular detection of human enteroviruses as a screening test followed by isolation on cell culture lines or sequencing could be proposed as a new diagnosis algorithm. The sensitivity of two molecular methods for the detection of enterovirus strains in 10 mL of sewage water (15 samples) was studied with Film Array ME panel BioFire (Biomerieux, France) and Xpert EV assay (Cepheid, USA). These are standardized methods for the detection of microorganisms in the cerebrospinal fluid (CSF). Of the 15 samples, six enterovirus strains were detected using Film Array ME, four enterovirus strains were detected using Xpert EV assay, while only two nonpolio enterovirus strains were isolated on RD cell line, using the standard WHO algorithm. However, only one of the strains detected by the standard WHO algorithm was detected by one of the molecular methods. The molecular methods for enterovirus detection are more sensitive than the virus isolation on cell culture lines, but in one case the virus isolated on RD cell line was not detected by the molecular methods. The results could be influenced by the small number of the samples investigated, by the volume and the concentration method used for samples tested, and by the limits of detection (LoD) of the enterovirus species in the samples, depending on the method used.