title: Diagnostic performance of a multiplex PCR assay for meningitis in an HIV-infected population in Uganda.
abstract: Meningitis remains a worldwide problem, and rapid diagnosis is essential to optimize survival. We evaluated the utility of a multiplex PCR test in differentiating possible etiologies of meningitis. Cerebrospinal fluid (CSF) from 69 HIV-infected Ugandan adults with meningitis was collected at diagnosis (n=51) and among persons with cryptococcal meningitis during therapeutic lumbar punctures (n=68). Cryopreserved CSF specimens were analyzed with BioFire FilmArray® Meningitis/Encephalitis panel, which targets 17 pathogens. The panel detected Cryptococcus in the CSF of patients diagnosed with a first episode of cryptococcal meningitis by fungal culture with 100% sensitivity and specificity and differentiated between fungal relapse and paradoxical immune reconstitution inflammatory syndrome in recurrent episodes. A negative FilmArray result was predictive of CSF sterility on follow-up lumbar punctures for cryptococcal meningitis. EBV was frequently detected in this immunosuppressed population (n=45). Other pathogens detected included: cytomegalovirus (n=2), varicella zoster virus (n=2), human herpes virus 6 (n=1), and Streptococcus pneumoniae (n=1). The FilmArray Meningitis/Encephalitis panel offers a promising platform for rapid meningitis diagnosis.
authors.affiliation: Division of Infectious Disease and International Health, Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Infectious Disease Institute, Makerere University, Kampala, Uganda. Electronic address: joshua.rhein@gmail.com.
authors.forename: Joshua
authors.initials: J
authors.lastname: Rhein
authors.affiliation: Division of Infectious Disease and International Health, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Nathan C
authors.initials: NC
authors.lastname: Bahr
authors.affiliation: BioFire Diagnostics, LLC, Salt Lake City, UT, USA.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Hemmert
authors.affiliation: BioFire Diagnostics, LLC, Salt Lake City, UT, USA.
authors.forename: Joann L
authors.initials: JL
authors.lastname: Cloud
authors.affiliation: BioFire Diagnostics, LLC, Salt Lake City, UT, USA.
authors.forename: Satya
authors.initials: S
authors.lastname: Bellamkonda
authors.affiliation: BioFire Diagnostics, LLC, Salt Lake City, UT, USA.
authors.forename: Cody
authors.initials: C
authors.lastname: Oswald
authors.affiliation: BioFire Diagnostics, LLC, Salt Lake City, UT, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Lo
authors.affiliation: Infectious Disease Institute, Makerere University, Kampala, Uganda.
authors.forename: Henry
authors.initials: H
authors.lastname: Nabeta
authors.affiliation: Infectious Disease Institute, Makerere University, Kampala, Uganda.
authors.forename: Reuben
authors.initials: R
authors.lastname: Kiggundu
authors.affiliation: Infectious Disease Institute, Makerere University, Kampala, Uganda.
authors.forename: Andrew
authors.initials: A
authors.lastname: Akampurira
authors.affiliation: Division of Infectious Disease and International Health, Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Infectious Disease Institute, Makerere University, Kampala, Uganda.
authors.forename: Abdu
authors.initials: A
authors.lastname: Musubire
authors.affiliation: Division of Infectious Disease and International Health, Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Infectious Disease Institute, Makerere University, Kampala, Uganda.
authors.forename: Darlisha A
authors.initials: DA
authors.lastname: Williams
authors.affiliation: Division of Infectious Disease and International Health, Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Infectious Disease Institute, Makerere University, Kampala, Uganda.
authors.forename: David B
authors.initials: DB
authors.lastname: Meya
authors.affiliation: Division of Infectious Disease and International Health, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Boulware
mesh_terms: D017088:AIDS-Related Opportunistic Infections; D000328:Adult; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008581:Meningitis / Q000175:diagnosis* / Q000382:microbiology*; D016919:Meningitis, Cryptococcal / Q000175:diagnosis / Q000382:microbiology; D060885:Multiplex Polymerase Chain Reaction / Q000379:methods / Q000592:standards; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014454:Uganda
keywords: Cryptococcal meningitis; Diagnostics; HIV; Immunocompromised; Meningitis; PCR