Rapid Diagnosis of Central Nervous System Infections by Multiplex PCR Assay and the Viral Etiology in Children

Central nervous system infections (CNS) are life-threatening infections in children, requiring urgent intervention and rapid diagnosis. In this study, we aimed to investigate the efficacy of syndromic tests in diagnosing CNS infections and the distribution of viral pathogens in pediatric patients. A total of 145 pediatric patients with a prediagnosis of CNS infection based on clinical findings by a pediatric infectious disease specialist were included in the study. Microscopic examination, biochemical tests, bacteriologic culture, and syndromic test (BioFire (R) FilmArray (R) Meningitis/Encephalitis Panel) were performed on cerebrospinal fluid samples obtained from the patients. Nearly half (44.8%) of the patients were younger than one year of age, the median age was 12 months (6-60 months), and the male-to-female ratio was 1.7, with 92 male and 53 female patients. Viral pathogens were observed in most of the 29 (18.8%) patients with syndromic test positivity (n= 23, 79.4%), while bacterial pathogens were detected in 20.6% (n= 6). No fungal pathogens were detected. Bacterial pathogens were Streptococcus pneumoniae [3.4% (5/145)] and Neisseria meningitidis [0.7% (1/145)]. Viruses were enterovirus [6.9% (10/145)], human herpesvirus-6 [5.5% (8/145)], herpes simplex virus type 1 [1.4% (2/145)], cytomegalovirus [0.7% (1/145)], human parechovirus [0.7% (1/145)], varicella zoster virus [0.7% (1/145)]. The main finding in cases with positive syndromic test was fever (n= 19, 65.5%), followed by vomiting (n= 15, 51.7%), convulsion (n= 14, 48.3%) and rash (n= 6, 20.6%). For turnaround time the median was 111 minutes and the mean was 119 minutes. Despite the lack of a performance study including sensitivity and specificity for syndromic testing or alternative tests for viral etiology, our study demonstrates the benefits of syndromic testing in children with presumed CNS infections, such as shortening the diagnostic period and guiding empirical treatment. It also constitutes an affirmative example of laboratory and clinical collaboration.