Diagnostic challenges of central nervous system infection: extensive multiplex panels versus stepwise guided approach.
BACKGROUND Cerebrospinal fluid (CSF) testing is a key component for the diagnosis of central nervous system (CNS) infections. Current meningitis and encephalitis management guidelines agree on the need for CSF molecular testing in combination with other direct and indirect biological testing, both in CSF and blood. Multiplex molecular tests have been developed to reduce turnaround times and facilitate the diagnostic approach. OBJECTIVES We aim to discuss the role of multiplex molecular panels in the management of CNS infections. SOURCES The MEDLINE database and the grey literature have been searched for relevant articles. CONTENT New molecular multiplex panels are being developed to simultaneously detect a large array of neuropathogens in CSF. While one of these assays has been FDA approved, extensive analytical and clinical validation is still missing, and suboptimal performance related issues have been raised. Its use has been associated with decreased costs and reduced length of hospital stay and antiviral therapy administration in retrospective, industry sponsored studies. The pros and cons of this multiplex syndromic approach are discussed in this narrative review. IMPLICATIONS Molecular multiplex CNS infection diagnosis panels have been developed and present several attractive features, including ease of use and low turnaround time. However, suboptimal analytical performances render these tests difficult to use without additional confirmatory tests. Such panels are not comprehensive nor adapted to all situations, depending on the epidemiological or clinical context. Overall, available data in the literature currently do not support the use of a multiplex PCR panel in clinical routine as a 'stand alone' molecular assay. Except in restricted laboratory capacity settings where such easy to use multiplex panels offer the diagnostic means that would otherwise be not available, the stepwise testing approach remains a more rational option. Serological testing both in blood and CSF should not be neglected, since it represents essential complementary tools regarding some neuropathogens.
Clinical microbiology and infection the official publication of the European Society of Clinical Microbiology and Infectious Diseases