Diagnostic performance of a multiplex PCR assay for meningitis in an HIV-infected population in Uganda

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.