Rhein Joshua, Bahr Nathan C, Hemmert Andrew C, Cloud Joann L, Bellamkonda Satya, Oswald Cody, Lo Eric, Nabeta Henry, Kiggundu Reuben, Akampurira Andrew, Musubire Abdu, Williams Darlisha A, Meya David B, Boulware David R
Division of Infectious Disease and International Health, Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Infectious Disease Institute, Makerere University, Kampala, Uganda.
Division of Infectious Disease and International Health, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Diagn Microbiol Infect Dis. 2016 Mar;84(3):268-73. doi: 10.1016/j.diagmicrobio.2015.11.017. Epub 2015 Dec 1.
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.
脑膜炎仍然是一个全球性问题，快速诊断对于提高生存率至关重要。我们评估了多重聚合酶链反应（PCR）检测在区分脑膜炎可能病因方面的效用。在诊断时收集了69名感染艾滋病毒的乌干达成年脑膜炎患者的脑脊液（CSF）（n = 51），并在治疗性腰椎穿刺期间收集了隐球菌性脑膜炎患者的脑脊液（n = 68）。使用靶向17种病原体的BioFire FilmArray®脑膜炎/脑炎检测板对冷冻保存的脑脊液标本进行分析。该检测板在通过真菌培养诊断为首次隐球菌性脑膜炎的患者脑脊液中检测隐球菌，灵敏度和特异性均为100%，并在复发性发作中区分真菌复发和矛盾性免疫重建炎症综合征。FilmArray检测结果为阴性可预测隐球菌性脑膜炎后续腰椎穿刺时脑脊液无菌。在这个免疫抑制人群中经常检测到EB病毒（n = 45）。检测到的其他病原体包括：巨细胞病毒（n = 2）、水痘带状疱疹病毒（n = 2）、人类疱疹病毒6型（n = 1）和肺炎链球菌（n = 1）。FilmArray脑膜炎/脑炎检测板为快速诊断脑膜炎提供了一个有前景的平台。
