如果不能准确诊断和治疗,中枢神经系统(CNS)的感染会导致严重的后果。涉及CNS感染的广谱病原体可能使诊断具有挑战性。基于聚合酶链反应(PCR)的多重分子诊断面板可以快速,同时检测脑脊液(CSF)中的多种神经病原体。本研究旨在评估生物快速脑膜炎/脑炎RT-PCRMX-17面板(Bioeksen,伊斯坦布尔,Türkiye),一种新的多重PCR测试,诊断中枢神经系统感染。该小组可以检测到一系列病原体,包括大肠杆菌K1流感嗜血杆菌,单核细胞增生李斯特菌,脑膜炎奈瑟菌,肺炎链球菌,无乳链球菌,肠道病毒(EV),单纯疱疹病毒(HSV)1和2,HHV-6,HHV-7,HHV-8,人副病毒(HPeV),水痘带状疱疹病毒(VZV),脑脊液样本中的巨细胞病毒(CMV)和隐球菌/新生球菌。这项回顾性研究包括2022年6月至2023年7月期间送往布尔萨乌卢达大学健康应用和研究中心微生物学实验室的128名患者的128份CSF样本,以寻找中枢神经系统感染因子。患者临床,放射学和实验室数据从医院信息记录系统(HIRS)收集.通过培养鉴定细菌病原体,而使用快速跟踪诊断(FTD)多重RT-PCR面板(FastTrackDiagnosticsLtd.,卢森堡)对于HSV-1、HSV-2、VZV,EV,腮腺炎病毒和HPeV.然后使用BioSpeedy面板测试储存的CSF样品,并将结果与培养物和FTD面板的结果进行比较。根据传染病和儿科传染病专家,如果检测到的病原体与患者的症状和CSF特征一致,则认为是阳性的。检测到但患者症状和脑脊液特征不支持的病原体被归类为不确定临床相关性(UCR)。在128名中枢神经系统感染因子检测患者中,44例(34.4%)被诊断为中枢神经系统感染。所有方法的病原体总检出率为43.2%(19/44)。Bio-Speedy小组在29.5%(13/44)的患者中发现了病原体,其次是FTD面板(20.5%,9/44)和文化(9.1%,4/44)。通过培养鉴定了四种细菌,其中三个也被Bio-Speedy小组检测到。此外,六种细菌被Bio-Speedy小组鉴定,没有被文化识别的。FTD小组确定了九种病毒,其中四个也被Bio-Speedy确定。总的来说,Bio-Speedy小组检测到19种阳性病原体中的13种(9种细菌和4种病毒:[S.肺炎(n=3),VZV(n=3),脑膜炎奈瑟球菌(n=2),流感嗜血杆菌(n=2),单核细胞增生性乳杆菌(n=1),大肠杆菌(n=1)veEV(n=1)]。然而,Bio-Speedy小组确定了15种病原体[S.肺炎(n=1),大肠杆菌(n=1),C.gatti/新生动物(n=1),CMV(n=8),HHV-6(n=3)veHHV-7(n=1)]被认为是UCR。Bio-Speedy在确诊中枢神经系统感染的患者中确定了最高百分比(29.5%)的病原体。然而,应根据患者特征解释检测结果,以确保对患者进行适当的管理.使用多种方法和多重测试可以提高中枢神经系统感染的诊断准确性。
Infections of the central nervous system (CNS) can lead to severe outcomes if not accurately diagnosed and treated. The broad spectrum of pathogens involved in CNS infections can make diagnosis challenging. Polymerase chain reaction (PCR) -based multiplex molecular diagnostic panels can rapidly and simultaneously detect multiple neuropathogens in cerebrospinal fluid (CSF). This study was aimed to assess the Bio-Speedy Meningitis/Encephalitis RT-PCR MX-17 panel (Bioeksen, İstanbul, Türkiye), a novel multiplex PCR test, in diagnosing CNS infections. The panel can detect a range of pathogens, including Escherichia coli K1, Haemophilus influenzae, Listeria monocytogenes, Neisseria meningitidis, Streptococcus pneumoniae, Streptococcus agalactiae, enterovirus (EV), herpes simplex virus (HSV) 1 and 2, HHV-6, HHV-7, HHV-8, human parechovirus (HPeV), varicella zoster virus (VZV), cytomegalovirus (CMV) and Cryptococcus gatti/neoformans in CSF samples. This retrospective study included 128 CSF samples from 128 patients sent to Bursa Uludağ University Health Application and Research Center Microbiology Laboratory between June 2022 and July 2023 to search for CNS infectious agents. Patient clinical, radiological and laboratory data were collected from the Hospital Information Record System (HIRS). Bacterial pathogens were identified through culture, while viral pathogens were detected in CSF samples using the Fast Track Diagnostics (FTD) multiplex RT-PCR panel (Fast Track Diagnostics Ltd., Luxembourg) for HSV-1, HSV-2, VZV, EV, mumps virus and HPeV. The stored CSF samples were then tested using the BioSpeedy panel and the results were compared with those of the culture and the FTD panel. Pathogens that were detected were considered positive if they were consistent with the patient\'s symptoms and CSF characteristics according to infectious disease and pediatric infectious disease specialists. Pathogens detected but not supported by the patient\'s symptoms and CSF characteristics were classified as uncertain clinical relevance (UCR). Out of the 128 patients tested for CNS infectious agents, 44 (34.4%) were diagnosed with a CNS infection. The overall pathogen detection rate with all methods was 43.2% (19/44). The Bio-Speedy panel identified pathogens in 29.5% (13/44) of the patients, followed by the FTD panel (20.5%, 9/44) and culture (9.1%, 4/44). Four bacteria were identified with culture, three of which were also detected by the Bio-Speedy panel. Additionally, six bacteria were identified with Bio-Speedy panel, that were not identified by culture. The FTD panel identified nine viruses, four of which were also identified by Bio-Speedy. In total, the Bio-Speedy panel detected 13 of the 19 positive pathogens (nine bacteria and four viruses: [S.pneumoniae (n= 3), VZV (n= 3), N.meningitidis (n= 2), H.influenzae (n= 2), L.monocytogenes (n= 1), E.coli (n= 1) ve EV (n= 1)]. However, the Bio-Speedy panel identified 15 pathogens [S.pneumoniae (n= 1), E.coli (n= 1), C.gatti/neoformans (n= 1), CMV (n= 8), HHV-6 (n= 3) ve HHV-7 (n= 1)] considered as UCR. The Bio-Speedy identified the causative pathogens in the highest percentage (29.5%) of patients with confirmed CNS infections. Nevertheless, test results should be interpreted based on patient characteristics to ensure appropriate patient management. Using multiple methods and multiplex tests may improve diagnostic accuracy for CNS infections.