Last modified: 2018-09-09
Abstract
Introduction: A variety of pathogens can cause infections in the central nervous system (CNS) in children with devastating consequences. Diagnostic methods that rapidly and comprehensively assess the causative agent facilitate early detection and treatment, and could alter the course of illness avoiding long-term brain injury.
Methods: Pathogens were identified by multiplexed PCR assays from DNA/RNA was extracted from CSF samples of 248 children with suspected CNS infections. We examined 22 viruses, 18 bacteria, 3 fungi, 1 parasite, Mycobacteria and Non-Tuberculous Mycobacteria.
Results: We found an almost equal prevalence of bacterial and viral infections (25% versus 23%). Mycobacterial and fungal infections accounted for 7% and 6% cases, respectively. Importantly, polymicrobial infections were seen in 12% cases.
Enteroviruses were implicated in 57% viral infections. Other viruses detected were HSV-1&2, CMV, Adenovirus, EBV, Mumps and Influenza. Among bacteria, Streptococcus species accounted for 10% of CNS infections with half of these caused by Streptococcus pneumoniae. Enterobacteriaceae family caused 6% of CNS infections while other Gram negative pathogens included Acinetobacter baumannii, Neisseria meningitides, Hemophilus influenza and Mycoplasma pneumoniae.
Conclusion: Using multiplexed PCR panels, our detection rate was 54% versus 12% when only single pathogens were probed (n=207; separate study). Syndromic evaluations facilitated detection of a wide variety of CNS pathogens within 8 hours. This enables timely treatment decisions and better outcome for patients. The significant proportion of polymicrobial infections also emphasizes the importance of syndromic evaluations.