Background/Objectives: Meningoencephalitis (ME) is a life-threatening infectious disease; therefore, prompt and accurate diagnosis is lifesaving. Traditional diagnostic methods, such as culture, have several limitations related to sensitivity and specificity. Emerging multiplex ME-PCR panels are a comprehensive and rapid tool in a single test. The Bio-Speedy Meningitis/Encephalitis RT-qPCR MX-17 panel (Bioeksen R&D Technologies Inc., Turkey) enables testing for 17 targets. To evaluate the performance of the panel compared to clinical and CSF parameters. Methods: A total of 403 patients with a preliminary diagnosis of ME were reviewed between January 2019 and September 2023. Following revision, 72 patients with clinical, CSF, and laboratory findings were included. The tested panel was used to detect targeted pathogens in CSF samples. The 30-day survival rate and prolonged stay were analyzed. Results: The median CSF protein value was 59.5 mg/dL (14.2–1471 mg/dL) and glucose was 61.95 mg/dL (0.083–165 mg/dL). Forty-one (56.9%) ME panel results were positive, among which 38.9% (28) were viral and 19.4% (14) were bacterial. HHV-6 ranked first with a rate of 15.3%. The Bio-Speedy panel test results outperformed the CSF culture (p < 0.001). The correlation of the Bio-Speedy panel with impaired consciousness was statistically significant (p = 0.004). Six (8.3%) patients from the study group died within 30 days. Conclusions: Compared to traditional methods, Bio-Speedy panel was effective in identifying the causative agents of ME. The Bio-Speedy ME RT-qPCR MX-17 panel offers accurate detection of ME-causing pathogens. The implementation of the panel in clinical practice can impact patient management and improve outcomes.

Human parechovirus (PeV) is an increasingly recognized cause of meningoencephalitis (ME) in infants. The US 2022 outbreak provided opportunity to analyze the clinical presentation and predictors of severe disease in affected infants. We conducted a multicenter retrospective review of infants diagnosed with PeV ME during the outbreak. We examined demographics, clinical features, laboratory findings, and neuroimaging results. Logistic regression was used to identify predictors of complicated disease and abnormal brain magnetic resonance imaging (MRI). Complicated disease was defined as requiring intensive care or findings of an abnormal brain MRI or electroencephalogram. 139 infants had PeV ME. The median age was 19days. Fever was the most common presenting symptom (89.2%) and was associated with uncomplicated disease and normal MRI. A total of 42 (30.2%) infants had complicated disease. Hypothermia (36.5% vs 5.1%), somnolence (38.1% vs 13.4%), poor feeding (76.1% vs 47.4%), hemodynamic instability (28.5% vs 3%), seizures (57.1% vs 4.1%), apnea (40.4% vs 0%), hypoglycemia (16.6% vs 1%), mechanical ventilation (23.8% vs 0%), and inotropic support (11.9% vs 0%) were associated with complicated disease. Younger age and seizures were predictors of abnormal MRI on multivariable analysis (adjusted odds ratio, 0.92 [0.48-0.99] and 40.1 [3.49-460.7], respectively). Laboratory findings, including cerebrospinal fluid indices, were rarely abnormal. Despite nonspecific symptoms on presentation and normal laboratory values, PeV can cause complicated disease, requiring clinicians to maintain high suspicion for this infection. We suggest PeV evaluation in workup of infant sepsis cases, neuroimaging in patients at high risk, and long-term developmental follow-up.

Introduction: Meningoencephalitis (ME) represents a serious neuroinfectious emergency, particularly in resource-limited countries where etiological diagnosis is often delayed or impossible. In sub-Saharan Africa, specific data in resuscitation are few. The objective was to describe the clinical profile, diagnostic and therapeutic challenges of ME in intensive care at the University Hospital of Angré. Methods: We conducted a 24-month retrospective observational study on patients admitted for ME, defined according to recognized clinical criteria, and who had received a lumbar puncture. Clinical data and standard analyses of the CSF were collected. The data was analyzed in a descriptive and univariate way with Epi Info TM. Results: The cohort included young patients (median age 13 years), with high severity at admission and significant mortality (70%). The lumbar puncture, performed in 63% of cases, showed an inflammatory CSF, but without etiological agent identification, notably due to the lack of advanced molecular tools. Co-infections and comorbidities, including HIV, complicated management. Conclusion: This study highlights the major diagnostic limitations and a high mortality rate, highlighting the urgency of improving diagnostic capabilities and therapeutic protocols in resource-limited settings to reduce morbidity and mortality associated with EM.

Background: Early/expedited discharge (ED) has been investigated for reducing hospital costs and improved patient outcomes in various medical conditions. Owing to high burden of hospitalization due to meningoencephalitis (ME) in pediatric patients, we evaluated predictors of ED at a tertiary care hospital in Karachi, Pakistan. Material and Methods: This retrospective cross-sectional study was conducted at a tertiary care hospital in Karachi, May 2017 to January 2023 Pakistan. All patients &lt;18 years admitted with suspicion of acute infectious ME who underwent CSF multiplex PCR panel (MenP) testing were included. Demographic, clinical and laboratory data were extracted from electronic medical records. Factors contributing to ED were identified by multivariate logistic regression using STATA 13.1 (Stata Corp, College Station, TX, USA). Results: Among 631 patients, 190 (30 %) achieved early discharge (ED). Viral pathogens were identified in 131 (21 %), tripling the odds of ED (OR 2.99, 95 % CI 1.92–4.66; p &lt; 0.001). Infants &lt;1 month (OR 0.23, 95 % CI 0.08–0.68), altered consciousness (OR 0.30, 95 % CI 0.17–0.67), positive blood cultures, and higher CSF protein (OR 0.99 per unit, 95 % CI 0.98–0.99) independently reduced ED likelihood in multivariate analysis. Conclusion: Diagnosis of a viral etiology in older children expedites hospital discharge. Thus, CSF molecular testing, particularly enterovirus PCR should be performed in pediatric patients with acute ME. Keywords: CSF, Early discharge, Enterovirus, Meningoencephalitis, Multiplex PCR, Pediatric, Viral etiology

Herpetic infection is a condition with high rates of neonatal morbidity and mortality; to date, there is no universally recognized strategy for the perinatal management of the risk of Herpes Simplex Virus (HSV) transmission based on the prognostic value attributed to maternal risk factors. Starting from the analysis of a clinical case of neonatal herpes meningoencephalitis, a literature review was conducted concerning the management of herpetic infection during pregnancy and in the neonatal period in terms of prevention and early diagnosis. The paper describes a case of a newborn with neonatal herpes meningoencephalitis transmitted by a mother with recurrent herpetic infection without clinically evident genital lesions at birth, despite the correct application of gynecological-neonatal protocols stratified by risk categories. An integrative model to the current guidelines should consider the following prophylactic strategies: performance of serological screening for HSV between the 24th and 28th week of pregnancy; provision of counseling regarding the main maternal-fetal and neonatal transmission risk factors for HSV; administration of antiviral prophylaxis with acyclovir to seropositive pregnant women starting from the 36th week of gestation; expansion of neonatal HSV-related screening tests even in cases where primary or recurrent genital lesions are present within ninety days before delivery. The diagnosis of neonatal herpetic meningoencephalitis suggests an underlying congenital error in innate immunity, related to an alteration in the TLR3/IFNα-β-λ axis, which presents with minimal/absent alterations in the immunological balance of I/II level, associated with infectious susceptibility to a restricted spectrum of viral pathogens, and deserves early immunological specialist evaluation.

We report the case of a 75-year-old woman admitted to the emergency department for confusion, gait disturbances and mutism associated with an inflammatory syndrome occurring 3 weeks after acute carbon monoxide intoxication. The main hypothesis upon arrival was infectious meningoencephalitis, and the patient was put on acyclovir and antibiotics in meningeal doses. After a short stay in intensive care, the patient’s condition did not improve, and the revaluation of her case history and imaging studies led to the diagnosis of post-interval syndrome secondary to carbon monoxide intoxication after a 3-week asymptomatic period. Post-interval syndrome is a complication poorly known to clinicians, manifesting as neuropsychiatric disorders after carbon monoxide intoxication despite an initial period of improvement. Repeated magnetic resonance imaging, in conjunction with compatible clinical findings, allow the diagnosis to be made. No neurological improved was noted after 6 months follow-up.

The rapid and broad microbiological diagnosis of meningoencephalitis (ME) has been possible thanks to the development of multiplex PCR tests applied to cerebrospinal fluid (CSF). We aimed to assess a new multiplex PCR panel (the QIAstat-Dx ME panel), which we compared to conventional diagnostic tools and the Biofire FilmArray ME Panel. The pathogens analyzed using both methods were Escherichia coli K1, Haemophilus influenzae, Listeria monocytogenes, Neisseria meningitidis, Streptococcus agalactiae, Streptococcus pneumoniae, Enterovirus, herpes simplex virus 1–2, human herpesvirus 6, human parechovirus, varicella zoster virus, and Cryptococcus neoformans/gattii. We used sensitivity, specificity, PPV, NPV, and kappa correlation index parameters to achieve our objective. Fifty CSF samples from patients with suspected ME were included. When conventional methods were used, 28 CSF samples (56%) were positive. The sensitivity and specificity for QIAstat-Dx/ME were 96.43% (CI95%, 79.8–99.8) and 95.24% (75.2–99.7), respectively, whereas the PPV and NPV were 96.43% (79.8–99.8) and 95.24% (75.1–99.7), respectively. The kappa value was 91.67%. Conclusions: A high correlation of the QIAstat-Dx ME panel with reference methods was shown. QIAstat-Dx ME is a rapid-PCR technique to be applied in patients with suspected ME with a high accuracy.

Background: Among the bacteria that affect the central nervous system, Listeria monocytogenes (facultative intracellular bacterium) is one of the most lethal to humans and animals. Listeriosis affects domestic and farm animals (pigs, small and large cattle, horses, rabbits, less often cats and dogs), as well as domestic and ornamental birds (geese, chickens, ducks, turkeys, pigeons, parrots and canaries). L. monocytogenes can be detected in fish and seafood (shrimp). The source of L. monocytogenes infection are animals in which the disease may manifest itself or occur in erased and asymptomatic forms followed by the transition to a long-term carriage. This pathogen is found throughout the world in foodstuffs, and most cases of infection occur through the ingestion of contaminated food. Particularly susceptible to the disease are embryos, newborns, the elderly and individuals with immunodeficiencies and chronic diseases. L. monocytogenes can cause intracranial hemorrhage, meningitis, meningoencephalitis, and rhombencephalitis. Clinical case description: This paper presents our own clinical observation of the development of severe listeriosis meningoencephalitis in a 47 year-old patient against the background of the new coronavirus infection (COVID-19). We describe the details of the clinical presentation, the treatment and the favorable outcome in our patient. Conclusion: Invasive listeriosis is a rare disease. The knowledge about the clinical manifestations of this disease is needed not only for epidemiologists and infectious disease specialists, but also for physicians of other specialties. Untimely diagnosis and inadequate antibacterial therapy are dangerous leading to severe somatic and neurological complications with a lethal outcome or disability both in children and adult persons.

Infectious meningoencephalitis (ME) is a major global health concern. Viruses are the most frequently implicated etiologies, whereas bacterial causes, although life-threatening, constitute a lesser proportion of ME cases, together with other pathogens. The strict implementation of COVID-19 mitigation measures led to the decreased viral and non-viral infectious diseases. Therefore, this study aimed to investigate the effect of these mea-sures on ME-causing pathogens by age groups. This retrospective study aimed to determine and compare the rates of pathogen-positive ME cases during the pre-pandemic (P-1) and pandemic (P-2) periods. Molecular diagnostic methods using the cerebrospinal fluid of patients from all age groups were included. The positivity rate difference of the ME-causing pathogens between the two study periods was compared and the distribution pattern of the pathogens among the age groups was determined. The overall positivity rate for at least one ME-causing pathogen during P-1 was 22.0% (503/2,284), which significantly declined to 7.3% (83/1,141) during P-2 (p < 0.001). Particularly, a statistically significant decline in the pathogen positivity was observed in the groups 4 - 6 (≥ 3 years) (p < 0.001, p < 0.001, and p = 0.041, respectively). Specifically, the enterovirus cases decreased significantly, whereas the varicella zoster virus and herpes simplex virus-2 cases increased. Among bacterial causes, the S. agalactiae, S. pneumoniae, and E. coli K1 ME cases significantly increased. Men and women had no significant differences in the positivity rate during either study period. COVID-19 mitigation measures significantly impacted the positivity rates and the distribution of ME-causing agents, especially in the age groups ≥ 3 years, although not uniformly.

The incidence of meningoencephalitis (ME) in India is poorly understood, and the exact etiological diagnosis is often not possible. This study was planned to elucidate the bacterial and viral etiological diagnosis of ME in children less than 5 years of age. The present study was conducted in Virus Research and Diagnostic Laboratory (VRDL), Department of Microbiology, King George's Medical University, Lucknow, from July 2020 to June 2022. Serum, cerebrospinal fluid (CSF), and nose/throat swabs were collected from all the enrolled cases of meningoencephalitis in children below 5 years of age and tested for various etiological agents by ELISA and/or real-time PCR. Of 130 enrolled cases, 50 (38.5%) cases tested positive for one or more etiological agents. Etiological agents of ME detected were Japanese encephalitis virus (JEV) (8.46%), adenovirus (6.92%), influenza virus (5.38%), dengue virus (3.85%), Parvo B-19 virus (3.08%), Orientia tsutsugamushi (3.08%), Herpes Simplex Virus-1 (HSV-1) (1.54%), measles virus (1.54%), and Varicella-Zoster Virus (VZV) (1.54%). Rubella virus, Chikungunya virus (CHKV), Mumps virus, Enteroviruses, Parecho virus, John Cunningham virus (JC), BK virus, Nipah virus, Kyasanur Forest Disease virus (KFD), Chandipura virus, Herpes Simplex Virus (HSV-2), SARS CoV-2, N. Meningitides , and H. Influenzae were tested but not detected in any of the cases. We identified the etiological agents in 50/130 (38.5%) suspected ME cases in children less than 5 years of age, using molecular and ELISA-based diagnostic methods. The four most common pathogens detected were JEV, adenovirus, influenza virus, and dengue virus.

Background and Objectives: Diagnosis of viral meningoencephalitis is very crucial for recognizing the occurrence of epidemics and for instituting appropriate treatment. The diagnostic capability of the country can be ascertained by studying the published reports of viral meningoencephalitis in our country from reputed scientific literature. Hence, we aimed to study the diagnostic methods used for viral meningo encephalitis from Indian studies indexed in PubMed database. Methods: The data was gathered from human studies of actual cases of viral meningitis, encephalitis or meningoencephalitis in India up to 8th August 2016 [earliest study found was from the year 1988] indexed in PubMed database. Results: A total of 186 articles were included from 1548 studies screened. Clinical diagnosis over arched all the methods of diagnosis of viral meningoencephalitis in all the studies. Only 23.1% studies reported definitive confirmation of the infectious agent by PCR. Only 34.3% studies reported any microbiological tests for viral etiology. SGPGI, NIV AND NIMHANS were the three major centers reporting molecular diagnosis. Over three decades PCR has superseded antibody testing for viral meningoencephalitis diagnosis. Interpretation and Conclusion: Our analysis shows that the diagnosis of viral meningo encephalitis in India is mainly based on clinical diagnosis. Definitive diagnosis by molecular diagnostic methods can be achieved with the establishment of a greater number of molecular viral diagnostic and research labs.

Epstein-Barr virus is a rare ethology of the neurological infections, expressed as encephalitis, aseptic meningitis, Guillain-Barre syndrome or acute demyelinating encephalomyelitis. Most common cases were reported in children, while this infection is rarely described in immunocompetent adults. We present the case of an elderly immunocompetent patient with hypertension and hypothyroidism under treatment who has presented to the emergency department for unusual headache, confusion, sudden loss of consciousness with retrograde amnesia, suddenly onset for 2 hours associated with febrile respiratory symptoms. Traumatic neurological events, cerebral ischemia or metabolic encephalopathies were ruled out, while examination of the cerebrospinal fluid was positive for Epstein-Barr virus. The course of the meningoencephalitis was favorable, although an episode of diarrhea with Clostridioides difficile with binary positive toxin A+B was notified. The primary infection or the reactivation of a previous infection, is a questionable mechanism of meningoencephalitis with Epstein Barr Virus in an old immunocompetent patient. According to the reported studies, the antiviral treatment with Acyclovir is controversial. The long-term prognosis of acute meningoencephalitis with Epstein-Barr virus is unpredictable and involves careful neurological and onco-hematological monitoring.

Abstract Studies related to neurological diseases are of great importance in Veterinary Medicine, particularly those involving production animals, such as cattle, due to their wide sanitary and public health significance. Therefore, the current study aims to describe the frequency of occurrence of the main clinical, laboratory, and anatomopathological findings of cattle diagnosed with neurological diseases of viral origin. Screening was performed in the general register of patients diagnosed through anatomopathological and/or complementary examination with illnesses of viral origin, admitted (live or dead) to the Clínica de Bovinos de Garanhuns-UFRPE from January 2009 to December 2019. The information recovered was entered in a database created in the computer program Microsoft Excel 2010®, distributed into clinical, laboratory, and anatomopathological data. The clinical findings on neurological diseases of viral etiology were very varied and non-specific, and the anatomopathological findings, together with laboratory methods, were of fundamental importance for the establishment of the diagnosis. The high frequency of rabies cases in this study demonstrates the importance of this disease for cattle rearing, as well as for Public Health. We emphasize the importance of including malignant catarrhal fever and herpes meningoencephalitis in the differential diagnosis of neurological diseases in the region, as well as the adoption of sanitary measures.

Abstract Background Decisions to discontinue antibiotics in infants undergoing evaluation for central nervous system (CNS) infection can be difficult. Previous reports have associated the use of the meningoencephalitis (ME) PCR panel with decreased hospital stay and antimicrobial use in pediatric and adult patients. However, limited focus has been on infants ≤60-days-old with temperature instability (TI) who undergo evaluation for serious bacterial infection based on age and risk-stratification. We hypothesize use of the ME panel will decrease the duration of antimicrobial use in infants with TI and negative bacterial cultures undergoing evaluation for CNS infection. Methods The electronic medical record was queried for patients that met inclusion criteria. Infants ≤60-days-old evaluated for CNS infection due to TI between 1/1/12 – 1/31/22 were included. Exclusion criteria were history of intracranial (IC) devices, previous IC surgery, IC structural or neurovascular abnormalities, or head trauma. A retrospective chart review was performed. We compared length of stay and antimicrobial duration for the groups of patients with the ME panel done versus not done. Results A total of 1808 patients with negative bacterial cultures were identified, 96 of whom had the ME panel performed. Patient age, sex, and race were similar between groups. The median hospital length of stay for the patients that had the ME panel done was 64.7 hours as compared to 47.8 hours for those that did not have the ME panel done. The duration of antibacterial therapy was similar when the ME panel was done versus not done. The median duration of therapy for acyclovir was 8.5 when the ME panel was done versus 14.8 hours when it was not done. Conclusion When including all patients ≤60-days-old evaluated for TI, use of the ME panel did not lead to a shorter length of hospital stay or duration of empiric antibiotics. However, use of the ME panel decreased duration of therapy in the subset of patients empirically started on acyclovir. Further data analysis will seek to identify patient populations that may most benefit from the use of the ME panel. Disclosures All Authors: No reported disclosures.

Abstract Background Human herpesvirus 6 (HHV-6) is ubiquitous and a known central nervous system (CNS) pathogen. However, HHV-6 in cerebrospinal fluid (CSF) without clinical findings of meningoencephalitis (ME) may not represent true infection, but rather, asymptomatic viral reactivation, chromosomal integration, or latent activation. With the introduction in 2015 of a rapid polymerase chain reaction (PCR) multiplex panel that simultaneously tests for 14 CNS pathogens, reports of HHV-6 PCR positive ME have increased. We sought to understand the epidemiology of HHV-6 ME by evaluating reported cases in Los Angeles County (LAC) between 2016-2020. Methods ME is a reportable condition in LAC. We reviewed clinical, laboratory, and radiologic data for all HHV-6 PCR positive cases reported in LAC between 2016-2020. We developed case classification categories, “unlikely,” “possible,” and “likely”, based on symptoms, CSF profile, and alternative diagnoses (see Table 1). Results A total of 67 HHV-6 ME cases were reported (see Table 2). Reports increased over time, with one in 2016, 12 in 2017, 17 in 2018, 20 in 2019, and 17 in 2020. Median age was 9 months (range 0d-78y), and 47 (70%) were &amp;lt; three years old. Forty-four (66%) were male. Six (9%) were immunocompromised, including one hematopoietic stem cell transplant recipient. Nineteen (28%) had abnormal CSF, and eight (12%) received therapy for HHV-6. Five cases (7%) were classified as “likely” HHV-6 ME, 12 (18%) “possible,” and 50 (75%) “unlikely”. The “likely” cases ranged in age from 7 months to 12 years old, and none were immunocompromised. One received antiviral therapy and was discharged to a rehabilitation facility, the other four were discharged home with full recovery. Conclusion The significance of HHV-6 in CSF remains challenging to determine both clinically and epidemiologically. In the setting of increased testing, increasing detection of HHV-6 in CSF may not reflect increasing rates of HHV-6 ME. The majority of reported HHV-6 ME cases were “unlikely” based on our classification. Classifying cases with alternative diagnoses as ‘unlikely” may miss cases with multiple true infections, particularly in the immunocompromised. It is important to consider clinical presentation, CSF profile and other diagnoses to understand the true burden of HHV-6 ME. Disclosures All Authors: No reported disclosures.

Background: For assessment of unconscious state in Medical Intensive Care Unit, physician mostly rely on Glasgow Coma Scale (GCS). But its verbal component has limitations in aphasic and intubated patient. More over its predilection ability to mortality is hardly challenged. The FOUR (Full outline of unresponsiveness) score, a new coma scale, evaluates 4 components: Eye, motor responses, brain stem reflexes and respiration. Aim of this study was to compare Full Outline of Unresponsiveness (FOUR) scale for prediction of mortality among patients admitted in Medical Intensive Care Unit (MICU) of a tertiary care hospital of Bangladesh with Glasgow Coma Scale (GCS). Objectives: To compare prediction of mortality between Glasgow Coma Scale (GCS) and Full Outline of Unresponsiveness (FOUR) scale. Methods: This is a prospective observational study was carried out in the Department of Critical Care Medicine, BIRDEM General Hospital to compare the mortality predilection in between FOUR score and GCS score. All consecutive adult unconscious patients over the age of 18 years were included in this study. Sedated patients were examined while they were not getting sedation or during routine sedation window period. Altered conscious level was examined by both GCS and FOUR scales. Data were collected using a check list containing demographic information, preexisting chronic illness, biochemical markers, imaging findings etc. Later patients were followed up and data regarding ICU stay, mortality and time of discharged from ICU were recorded. Both GCS and FOUR score were compared between survivor and non-survivor group and compared both score in between non-survivor group. Ultimately data were analyzed by using Statistical Package for Social Sciences (SPSS) software (version 20). Results: Total 105 unconscious patients were enrolled within the study after fulfilling inclusion &amp; exclusion criteria. Among them 34 patients were survivor and 71 patient were non-survivor. The mean and SD of age in this study were 64 .55 ±14.65 years. The peak age distribution was (61-70) 39%. Among them 54.3 % (n=57) were male and 45.7 % (n=48) were female. DM (82.85%) was the most common comorbidity and the predominant diagnosis was Septic shock 33% followed by Ischemic stroke 29%, Meningo encephalitis 19.04 %, and Electrolytes imbalance 17.14%, Cardiogenic shock 12.38% etc. In both GCS and FOUR score their value significantly differ in case of both survival ([7.15± 1.56]; P&lt;.0001 and [7.74± 2.26]; P&lt;.0001) and non-survival group ([5.38± 1.96]; P &lt;0.0001) and ([5.35± 2.83]; P &lt;0.0001). But comparison of FOUR score (5.35± 2.83) with GCS (5.38± 1.96) in terms of predicting mortality their value not significantly differ (P &lt;0.93). So both GCS and FOUR score is equally effective predicting mortality among unconscious patients. Conclusion: Both GCS and FOUR score significantly vary among survivor and non-survivor groups of unconscious patients but while comparing them regarding predicting mortality there is no significant differences in both score. Finally we conclude that both GCS and FOUR score equally good at predicting in hospital mortality among unconscious patients admitted in MICU. Bangladesh Crit Care J September 2022; 10(2): 76-81

Scrub typhus is being reported as the most common cause of childhood meningoencephalitis (ME) in India. Hence, we planned to estimate the proportion of scrub typhus infection among children aged 1 month to 12 years with the clinical diagnosis of ME and to evaluate their demographic, clinical and laboratory characteristics. This cohort study was conducted in the Department of Pediatrics of a tertiary care teaching hospital in south India. One hundred and twenty-seven consecutive children aged 1 month to 12 years with the clinical diagnosis of ME were the participants. Their socio-demographic factors, clinical details, laboratory reports and outcomes were analyzed. The etiological agent was identified in 71 (56%) children. Orientia tsutsugamushi (Scrub typhus) was the most common infection (24.4%), of all children with ME. Children aged ≥5 years were frequently affected by scrub typhus ME. Eschar, capillary leak, hepatomegaly and splenomegaly were the predominant clinical features of scrub typhus ME. Thrombocytopenia and deranged liver function tests were common in scrub typhus ME. To conclude, Orientia tsutsugamushi was the most common organism identified in our study. Prompt recognition of some tell-tale clinical signs of scrub typhus (such as eschar, thrombocytopenia and hepatosplenomegaly), and timely initiation of antibiotics would lead to better outcomes as evident from the study.

BackgroundAcute meningoencephalitis is encountered commonly in the acute hospital setting and is associated with significant morbidity and mortality, in addition to significant healthcare costs. Multiplex PCR panels now allow syndromic testing for central nervous system infection. The BioFire® FilmArray® Meningoencephalitis (ME) allows testing of 14 target pathogens using only 0.2mls of cerebrospinal fluid (CSF). We conducted a retrospective observational study to assess the performance of the assay and secondarily to observe the clinical utility of negative results by comparing clinical outcomes of aseptic meningitis to bacterial and viral meningoencephalitis.MethodsData for CSF samples tested using the FilmArray ME panel from October 2017 to October 2020 were analysed. Detection of bacterial and viral targets was analysed. Admission to critical care area, 90-day readmission rates, average length of stay and 30-day and 90-day mortality were analysed for three groups with following diagnoses: bacterial meningitis, viral meningoencephalitis, or aseptic meningitis.ResultsFrom October 2017 to October 2020, 1926 CSF samples were received in the Clinical Microbiology laboratory. Of those, 543 CSF samples from 512 individual patients were tested using the FilmArray ME panel. Twenty-one bacterial targets and 56 viral targets were detected during the study period. For viral targets, the cumulative specificity was 98.9% (95% confidence interval: 93.1–99.9) when compared to the reference laboratory methods. The outcomes for 30- and 90-day mortality of the aseptic meningitis group were non-inferior relative to the viral meningoencephalitis and bacterial meningitis group. Patients with bacterial meningitis had a longer average length of stay. Aseptic meningitis was associated with a higher 90-day readmission rate than the other 2 groups, but without statistical significance.ConclusionIn our hands, implementation of the FilmArray ME panel was relatively straightforward. We experienced a transition in our workflow processes that enabled streamlining of CSF diagnostics and the safe removal of Gram staining in those samples being tested by this molecular assay. Coupled to this improvement, there was a positive clinical impact on patient care due to rapid turnaround time to results.

IntroductionEarly identification of etiology is very important for initiating appropriate therapy promptly in patients with meningoencephalitis (ME). BioFire FilmArray® meningitis/encephalitis (FA-ME) panel is a fully automated multiplex polymerase chain reaction (PCR) that detects 14 pathogens simultaneously in an hour. There is a dearth of studies highlighting its usefulness in ME syndrome in Indian patients.Materials and methodsWe performed a retrospective analysis of patients, admitted to the Kerala Institute of Medical Sciences Hospital, Thiruvananthapuram, Kerala, South India, with meningitis/encephalitis syndrome who underwent the multiplex PCR test on cerebrospinal fluid (CSF) over a period of 2 years from 2016 to 2018. Patients presenting with clinical diagnosis of acute meningitis, encephalitis, or ME who underwent CSF FA-ME panel were studied. The performance of the FA-ME panel was compared to CSF bacterial culture.ResultsTwo-hundred and fifty-nine patients between December 2016 and December 2018 underwent the FA-ME test in CSF. FA-ME test detected pathogens in 61 (23.6%) out of 259 patients with ME syndrome. Among the pathogens detected by FA-ME panel, enterovirus was the commonest accounting for 29 cases (47.5%), followed by varicella in 11 patients (18%) and pneumococci in 9 (14.8%). CSF bacterial culture yield was low, positive only in 8 (3%) out of 259 cases, and matched with FA-ME panel in only one sample that grew Streptococcus pneumoniae. Bacterial culture yielded seven pathogens in those whose FA-ME panels were negative.ConclusionFA-ME panel improves diagnostic yield as compared to bacterial culture (26.3 vs 3%). FA-ME test helps in the early initiation of targeted antibiotic therapy and greater antibiotic de-escalation.How to cite this articleChandran S, Arjun R, Sasidharan A, Niyas VKM, Chandran S. Clinical Performance of FilmArray Meningitis/Encephalitis Multiplex Polymerase Chain Reaction Panel in Central Nervous System Infections. Indian J Crit Care Med 2022;26(1):67–70.

Pituitary apoplexy (PA) is extremely rare in children and adolescents. It is a life-threatening condition usually results from sudden hemorrhage or infarction induced swelling in a pituitary adenoma. The clinical manifestations of PA include severe headaches, impaired consciousness, fever, visual disturbance, and variable ocular paresis. Therefore, the presence of meningeal irritation may lead to misdiagnosis as a case of meningoencephalitis or spontaneous subarachnoid hemorrhage, and delay in the proper management of the disease. We report a case of 17-year-old pubertal boy who developed sudden severe headache, vomiting, slurring of speech and abnormal behaviour followed by impaired sensorium with fever. The patient who was initially diagnosed with meningoencephalitis (ME) based on clinical presentation and cerebrospinal fluid (CSF) analysis, which was consistent with bacterial meningitis. MRI of brain was performed, confirming a pituitary macroadenoma with hemorrhage and ischemic changes in both basal ganglia and pons. A complete analysis of the pituitary hormones revealed decreased cortisol and thyroid hormone level and hyperprolactinemia and he was subsequently started on placement corticosteroid and L-thyroxine therapy and cabergoline. After 14/ days of antimicrobial therapy with ceftriaxone and ampicillin, the patient improved and was discharged on hormone replacement therapy and surgical advised. Hereby, we report our case with a review of literatures. Bangladesh J Medicine July 2022; 33(1) : 85-88