Diagnostic performance of a multiplex PCR assay for meningitis in an HIV-infected population in Uganda

Diagn Microbiol Infect Dis. 2016 Mar;84(3):268-73. doi: 10.1016/j.diagmicrobio.2015.11.017. Epub 2015 Dec 1.

Abstract

Meningitis remains a worldwide problem, and rapid diagnosis is essential to optimize survival. We evaluated the utility of a multiplex PCR test in differentiating possible etiologies of meningitis. Cerebrospinal fluid (CSF) from 69 HIV-infected Ugandan adults with meningitis was collected at diagnosis (n=51) and among persons with cryptococcal meningitis during therapeutic lumbar punctures (n=68). Cryopreserved CSF specimens were analyzed with BioFire FilmArray® Meningitis/Encephalitis panel, which targets 17 pathogens. The panel detected Cryptococcus in the CSF of patients diagnosed with a first episode of cryptococcal meningitis by fungal culture with 100% sensitivity and specificity and differentiated between fungal relapse and paradoxical immune reconstitution inflammatory syndrome in recurrent episodes. A negative FilmArray result was predictive of CSF sterility on follow-up lumbar punctures for cryptococcal meningitis. EBV was frequently detected in this immunosuppressed population (n=45). Other pathogens detected included: cytomegalovirus (n=2), varicella zoster virus (n=2), human herpes virus 6 (n=1), and Streptococcus pneumoniae (n=1). The FilmArray Meningitis/Encephalitis panel offers a promising platform for rapid meningitis diagnosis.

Keywords: Cryptococcal meningitis; Diagnostics; HIV; Immunocompromised; Meningitis; PCR.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • AIDS-Related Opportunistic Infections*
  • Adult
  • CD4 Lymphocyte Count
  • Cohort Studies
  • Female
  • Humans
  • Immunocompromised Host
  • Male
  • Meningitis / diagnosis*
  • Meningitis / microbiology*
  • Meningitis, Cryptococcal / diagnosis
  • Meningitis, Cryptococcal / microbiology
  • Multiplex Polymerase Chain Reaction* / methods
  • Multiplex Polymerase Chain Reaction* / standards
  • Prospective Studies
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Uganda