Related Experiment Video
Updated: Aug 5, 2026
Metagenomic Next-Generation Sequencing of Cerebrospinal Fluid for the Detection of Central Nervous System Pathogens
Published on: April 17, 2026
Epidemiological and Laboratory Evaluation of Central Nervous System Infections Using the BioFire FilmArray
Serpil S Çuğlan1, Arzu İrvem1, Mahmure Aslan2
1Department of Medical Microbiology, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Türkiye.
Objective:
Rapid and accurate identification of central nervous system (CNS) pathogens is essential for appropriate antimicrobial management. This study aimed to evaluate the performance of the BioFire FilmArray Meningitis/Encephalitis (ME) Panel compared with conventional cerebrospinal fluid (CSF) analysis.
Materials And Methods:
This retrospective study was conducted at a tertiary care hospital over a three-year period. Cerebrospinal fluid samples were analyzed using routine microbiological methods (culture and Gram staining), cytological examination, biochemical testing, and multiplex PCR with the BioFire FilmArray ME Panel.
Results:
A total of 1470 CSF samples were analyzed, and pathogens were detected in 104 samples (7.1%), including 57 viral pathogens, 39 bacterial pathogens, one fungal pathogen, and six co-infections. Culture positivity was observed in one case each of Streptococcus pneumoniae and Cryptococcus neoformans, both concordant with PCR findings. Bacterial infections were associated with significantly lower CSF glucose levels (42.57 ± 26.07 mg/dL) and higher lactate dehydrogenase (LDH) levels (320.33 ± 455.76 IU/L) than viral infections (60.38 ± 18.88 mg/dL and 53.08 ± 26.85 IU/L, respectively). The proportion of polymorphonuclear leukocytes (PMNLs) was significantly higher in bacterial cases. Receiver operating characteristic (ROC) analysis demonstrated good discriminatory performance for LDH (area under the receiver operating characteristic curve [AUC] = 0.917) and PMNL percentage (AUC = 0.834). Viral pathogens were more frequent in the 0-2-year age group, whereas bacterial infections predominated in older children.
Conclusion:
The BioFire FilmArray ME Panel, when interpreted in conjunction with routine CSF biochemical and cytological parameters, provides a rapid and reliable diagnostic approach for differentiating bacterial from viral CNS infections.
Graphical Abstract:
Graphical Abstract.
