title: How appropriate are cerebrospinal fluid polymerase chain reaction requests for suspected central nervous system infections?
abstract: Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) assays have become the main diagnostic tests for central nervous system viral infections in recent years. Previous studies have suggested algorithms based on CSF leukocyte count and total protein levels to determine when CSF PCR assays are indicated. Based on these criteria, 1,469 CSF PCR tests requested over a two-year period were reviewed. A proportion of positive PCR results were found in children with normal CSF, unlike in adults where such occurrences were extremely rare. The results suggest that applying a strategy of screening CSF specimens using leukocyte count, glucose and protein, at least in adults, may have avoided more than half of CSF PCR requests with little detriment to patient care and considerable cost savings. Larger prospective studies are needed to determine whether algorithms using standard CSF parameters and clinical information can optimise the use of CSF PCR assays in clinical practice.
authors.affiliation: Department of Infection and Travel Medicine, James Cook University Hospital, Middlesbrough.
authors.forename: Yaasir
authors.initials: Y
authors.lastname: Mamoojee
authors.forename: David
authors.initials: D
authors.lastname: Chadwick
mesh_terms: D020806:Central Nervous System Bacterial Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis; D020805:Central Nervous System Viral Diseases / Q000134:cerebrospinal fluid* / Q000175:diagnosis*; D002555:Cerebrospinal Fluid / Q000166:cytology; D002556:Cerebrospinal Fluid Proteins / Q000032:analysis; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D014780:Viruses / Q000302:isolation & purification
chemical_list: D002556:Cerebrospinal Fluid Proteins