A faster diagnostic option for meningitis and encephalitis
The problem with traditional meningitis/encephalitis testingDoctors traditionally rely on several different tests to diagnose CNS infections (9,10). These methods include:
- Computerized tomography (CT) or magnetic resonance imaging (MRI) scans
- Blood draw, followed by blood chemistry and blood culture
- Lumbar puncture, followed by cerebrospinal fluid (CSF) microbiology and chemistry, including CSF culture, Gram stain and latex agglutination assays
- Traditional molecular diagnostics using single-target PCR and send out tests
- Time: While some of these traditional methods can provide results in a matter of hours, it can take up to two days or more for pathogen identification from CSF culture (9). And if send-out tests are required, results are typically delivered in days, not hours.
- Labor and expertise: Most traditional methods for diagnosing CNS infections take time, effort and specific expertise to complete. Further, distinct assays – and distinct sets of expertise – are required to determine if the cause of the infection is viral or bacterial (9).
- Low diagnostic yields: The rate of pathogen identification from CSF and blood culture varies between 62–97% and 40–90%, respectively, depending on a patient’s antibiotic status and the pathogen causing the infection (9). The efficacy of Gram stain and latex agglutination are also impacted if a patient has received prior antibiotic treatment. The sensitivity of bacterial meningitis Gram stain is around 60%, while the sensitivity for latex agglutination ranges from 7–100% (9).
- Limited CSF sample volumes: For CSF-based assays, all of these methods must rely on the limited volume of CSF that is collected from patients during a lumbar puncture.
What is multiplex syndromic testing?The U.S. Food and Drug Administration cleared the first syndromic testing panel in 2008 (10). Since then, syndromic testing has become increasingly available to doctors for diagnosing various ailments, including CNS infections.
Syndromic testing uses multiplexed real-time polymerase chain reaction (PCR) to analyze multiple bacterial, viral and fungal pathogens simultaneously in a small patient sample. Doing so helps doctors accurately diagnose patients presenting with many overlapping symptoms.
And syndromic testing is faster and easier to conduct than most traditional methods. For example, a single syndromic test can deliver results in about an hour. These tests provide two possible results: positive or negative. Syndromic testing’s binary results eliminate the subjective readings of traditional meningitis and encephalitis tests.
Benefits of syndromic testing for CNS infections
Syndromic testing is an ideal supportive diagnostic technique for meningitis and encephalitis since time is critical when treating these infections. Syndromic testing has the potential to:
- Significantly reduce the time to diagnosis, which could reduce the risk of death and long-term complications in patients with CNS infections (11,12).
- Quickly distinguish between viral and bacterial meningitis pathogens, enabling targeted treatment decisions to be made (11,13).
- Decrease a patient’s time in the hospital (11,12,14), lowering the risk of hospital-acquired infections and saving on overall healthcare costs (11,14,15).
- Support antimicrobial stewardship efforts by increasing diagnostic certainty, which can help optimize antimicrobial use (including de-escalation) (16) and reduce the risk of antimicrobial resistance emerging.
Syndromic testing delivers these benefits by providing fast, evidence-based pathogen identification, which enables improved patient management and targeted treatment to be initiated sooner.
A better way to diagnose CNS infectionsFast, reliable results are critical for diagnosing and treating meningitis and encephalitis. Fortunately, syndromic testing delivers fast, accurate results for pathogens most often associated with CNS infections.
With syndromic testing, you can:
- Run tests on-demand, 24/7, without needing many highly-trained lab staff with specific expertise
- Get comprehensive results, including differentiating bacterial, viral and fungal pathogens, in about an hour
- Provide improved, evidence-based care for your patients
- Meningitis Now. https://www.meningitisnow.org/support-us/news-centre/meningitis-stories/david-ms-story/.
- Meningitis Research Foundation. https://www.meningitis.org/meningitis/the-global-burden-of-meningitis.
- Durand M.L. et al. (1993) N Engl J Med. 328(1), 21–28. doi: 10.1056/NEJM199301073280104.
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- Cedars-Sinai.org. https://www.cedars-sinai.org/health-library/diseases-and-conditions/b/bacterial-meningitis.html.
- Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/meningitis/diagnosis-treatment/drc-20350514.
- Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/encephalitis.
- Van de Beek D. et al. (2016) Cli Microbiol Infect. 22, S37–S62. doi: 10.1016/j.cmi.2016.01.007.
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- Cailleaux M. et al. (2019) Eur J Clin Microbiol Infect Dis. 39, 293–297. https://doi.org/10.1007/s10096-019-03724-7.
- O’Brien M, et al. (2018) J. Pediatr. Infect. Dis. 37, 868-71
- Leber A. et al. (2016) J Clin Microbiol. 59(4), 2251–2261. doi: https://doi.org/10.1128/JCM.00730-16.
- Moffa M.A., et al. (2020) Antibiotics (Basel). 9(6), 282 doi: 10.3390/antibiotics9060282.
- Posnakoglou L. et al. (2020) Eur J Clin Microbiol Infect Dis. 39, 2379–2386. doi:10.1007/s10096-020-03986-6.
- Hagen, A. et al. (2020) BMC. Pediatr. 20(1), 56.
- PATH. https://www.path.org/articles/toward-world-without-meningitis/.
- Dumkow. LED. Worden. LJW. Rao. SNR. 2021. Syndromic diagnostic testing: a new way to approach patient care in the treatment of infectious diseases. Journal of Antimicrobial Chemotherapy. Pages iii4–iii11.