Enhancing pathogen identification in patients with meningitis and a negative Gram stain using the BioFire FilmArray® Meningitis/Encephalitis panel

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Abstract

Background

Meningitis with a negative cerebrospinal (CSF) Gram stain represents a diagnostic and therapeutic challenge. The purpose of our study was to evaluate the performance of the BioFire FilmArray ^® Meningitis/Encephalitis (FA ME) panel in patients presenting with community-acquired meningitis with a negative Gram stain.

Methods

CSF from 48 patients with community-acquired meningitis with a negative Gram stain admitted to four hospitals in Houston, TX underwent additional testing by the FA ME. FA ME results were compared to results obtained as part of routine evaluation.

Results

The panel detected pathogens not previously identified in 11 (22.9 %) of 48, but did not detect pathogens identified by standard technique (West Nile virus, Histoplasma) in 5 (15.2 %) patients.

Conclusions

Rapid testing for the most common pathogens causing meningitis will aid in the diagnosis and treatment of patients with meningitis.

Related collections

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The ideal clinical diagnostic system should deliver rapid, sensitive, specific and reproducible results while minimizing the requirements for specialized laboratory facilities and skilled technicians. We describe an integrated diagnostic platform, the “FilmArray”, which fully automates the detection and identification of multiple organisms from a single sample in about one hour. An unprocessed biologic/clinical sample is subjected to nucleic acid purification, reverse transcription, a high-order nested multiplex polymerase chain reaction and amplicon melt curve analysis. Biochemical reactions are enclosed in a disposable pouch, minimizing the PCR contamination risk. FilmArray has the potential to detect greater than 100 different nucleic acid targets at one time. These features make the system well-suited for molecular detection of infectious agents. Validation of the FilmArray technology was achieved through development of a panel of assays capable of identifying 21 common viral and bacterial respiratory pathogens. Initial testing of the system using both cultured organisms and clinical nasal aspirates obtained from children demonstrated an analytical and clinical sensitivity and specificity comparable to existing diagnostic platforms. We demonstrate that automated identification of pathogens from their corresponding target amplicon(s) can be accomplished by analysis of the DNA melting curve of the amplicon.

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Author and article information

Contributors

Susan H. Wootton: Susan.H.Wootton@uth.tmc.edu

Elizabeth Aguilera: Elizabeth.Aguilera@uth.tmc.edu

Lucrecia Salazar: Lucrecia.Salazar@uth.tmc.edu

Andrew C. Hemmert: Andrew.Hemmert@biofiredx.com

Rodrigo Hasbun: (713) 500-7140 , Rodrigo.Hasbun@uth.tmc.edu

Journal

Journal ID (nlm-ta): Ann Clin Microbiol Antimicrob

Journal ID (iso-abbrev): Ann. Clin. Microbiol. Antimicrob

Title: Annals of Clinical Microbiology and Antimicrobials

Publisher: BioMed Central (London )

ISSN (Electronic): 1476-0711

Publication date (Electronic): 21 April 2016

Publication date PMC-release: 21 April 2016

Publication date Collection: 2016

Volume: 15

Electronic Location Identifier: 26

Affiliations

[ ]Division of Infectious Diseases, Department of Pediatrics, University of Texas (UT) Health Science Center, Houston, TX 77030 USA

[ ]Division of Infectious Diseases, Department of Internal Medicine, University of Texas (UT) Health Science Center, 6431 Fannin St. 2.112 MSB, Houston, TX 77030 USA

[ ]BioFire Diagnostics, LLC, Salt Lake City, 84108 USA

Article

Publisher ID: 137

DOI: 10.1186/s12941-016-0137-1

PMC ID: 4839114

PubMed ID: 27101869

SO-VID: 1ae5587f-ed6f-449f-9555-cb15b2a9116d

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 20 February 2016

Date accepted : 29 March 2016

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000002, National Institutes of Health;

Award ID: 1 K23 RR01892901A2

Award Recipient : Rodrigo Hasbun

Custom metadata

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: aseptic meningitis,encephalitis,molecular diagnostic techniques,polymerase chain reaction

Data availability:

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: aseptic meningitis, encephalitis, molecular diagnostic techniques, polymerase chain reaction