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Clinical Performance of FilmArray Meningitis/Encephalitis Multiplex Polymerase Chain Reaction Panel in Central

Sarath Chandran¹, Rajalakshmi Arjun², Aswathy Sasidharan²

¹Department of Internal Medicine, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India.

Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine

|February 3, 2022

Abstract

Introduction:

Early 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 Methods:

We 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.

Results:

Two-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.

Conclusion:

FA-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 Article:

Chandran 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.

Insights

The BioFire FilmArray meningitis/encephalitis (FA-ME) panel significantly improves pathogen detection in central nervous system infections compared to bacterial culture. This rapid multiplex PCR test aids in early, targeted antibiotic therapy for meningitis and encephalitis patients.

Area of Science:

Clinical Microbiology
Infectious Diseases
Molecular Diagnostics

Background:

Early identification of the cause of meningoencephalitis (ME) is crucial for prompt and effective treatment.
The BioFire FilmArray meningitis/encephalitis (FA-ME) panel offers rapid, simultaneous detection of 14 ME pathogens.
Limited data exists on the FA-ME panel's utility in the Indian population for ME syndrome.

Purpose of the Study:

To evaluate the clinical performance of the FA-ME panel in diagnosing meningitis/encephalitis (ME) in Indian patients.
To compare the diagnostic yield of the FA-ME panel with conventional CSF bacterial culture.
To assess the impact of the FA-ME panel on initiating targeted antibiotic therapy.

Main Methods:

Retrospective analysis of 259 patients with ME syndrome admitted to Kerala Institute of Medical Sciences from 2016-2018.
Cerebrospinal fluid (CSF) samples were tested using the FA-ME multiplex PCR panel.
FA-ME panel results were compared against CSF bacterial culture findings.

Main Results:

The FA-ME panel detected pathogens in 23.6% (61/259) of ME cases.
Enterovirus (47.5%), varicella (18%), and Streptococcus pneumoniae (14.8%) were the most common pathogens identified by FA-ME.
CSF bacterial culture had a low yield (3%), with only one positive match to the FA-ME panel; it identified seven additional pathogens.

Conclusions:

The FA-ME panel demonstrated a significantly higher diagnostic yield (26.3%) compared to bacterial culture (3%) for ME syndrome.
The FA-ME panel facilitates earlier initiation of targeted antibiotic treatment.
Utilizing the FA-ME panel can lead to more effective antibiotic de-escalation strategies.

Read full analysis

Keywords:

Acute meningitis Encephalopathy Polymerase chain reaction

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