Diagnostic challenges of central nervous system infection: extensive multiplex panels versus stepwise guided approach

Article Article scientifique Revue de la littérature Diagnostic challenges of central nervous system infection: extensive multiplex panels versus stepwise guided approach eng 2019-12-31 2020-06 author Vetter Pauline Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland; Infectious Diseases Division, Geneva University Hospitals, Geneva, Switzerland. Electronic address: pauline.vetter@hcuge.ch. 673142 author Schibler Manuel Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland; Infectious Diseases Division, Geneva University Hospitals, Geneva, Switzerland. 96444 Département de médecine (DEMED) author Herrmann Jil-Nora 2I, UVSQ, INSERM, Université Paris Saclay, Versailles France; AP-HP, GHU Paris Saclay, Hôpital Raymond Poincaré, Garches, France. 929413 author Boutolleau D Sorbonne Université, INSERM, Institut Pierre Louis D'Epidémiologie et de Santé Publique (iPLESP), Paris, France; AP-HP, GHU AP-HP. Sorbonne Université, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Virology Department, National Reference Center for Herpesviruses (associate Laboratory), Paris, France. 706-712 10.1016/j.cmi.2019.12.013 31899336 1198-743X https://www.sciencedirect.com/science/article/pii/S1198743X19306706 Background: Cerebrospinal fluid (CSF) testing is a key component for the diagnosis of central nervous system (CNS) infections. Current meningitis and encephalitis management guidelines agree on the need for CSF molecular testing in combination with other direct and indirect biological testing, both in CSF and blood. Multiplex molecular tests have been developed to reduce turnaround times and facilitate the diagnostic approach. Objectives: We aim to discuss the role of multiplex molecular panels in the management of CNS infections. Sources: The MEDLINE database and the grey literature have been searched for relevant articles. Content: New molecular multiplex panels are being developed to simultaneously detect a large array of neuropathogens in CSF. Although one of these assays has been US Food and Drug Administration-approved, extensive analytical and clinical validation is still missing, and suboptimal performance related issues have been raised. Its use has been associated with decreased costs, reduced length of hospital stay and reduced antiviral therapy administration in retrospective, industry-sponsored studies. The pros and cons of this multiplex syndromic approach are discussed in this narrative review. Implications: Molecular multiplex CNS infection diagnosis panels have been developed and present several attractive features, including ease of use and low turnaround time. However, suboptimal analytical performances render these tests difficult to use without additional confirmatory tests. Such panels are not comprehensive nor adapted to all situations, depending on the epidemiological or clinical context. Overall, available data in the literature currently do not support the use of a multiplex PCR panel in clinical routine as a 'stand-alone' molecular assay. Except in restricted laboratory capacity settings where such easy-to-use multiplex panels offer the diagnostic means that would otherwise not be available, the stepwise testing approach remains a more rational option. Serological testing both in blood and CSF should not be neglected, but it represents essential complementary tools regarding some neuropathogens. Central nervous system infection Diagnostic strategy Encephalitis Meningitis Multiplex PCR panels Stepwise microbiological testing Central Nervous System Infections / cerebrospinal fluid Central Nervous System Infections / diagnosis Diagnostic Tests, Routine / methods Diagnostic Tests, Routine / standards Encephalitis / diagnosis Humans Meningitis / diagnosis Molecular Diagnostic Techniques / methods Molecular Diagnostic Techniques / standards Retrospective Studies Dewey 616 56 Département de médecine 221 false 400 Virologie clinique 668 Clinical microbiology and infection 26 6 8cfc5ee8-24c5-47a7-b60e-03644690f50c Article (Published version) Public VetterP_Diagnostic_challenges_centr.pdf 481816 application/pdf OA OTHER 4bdc87268250d0dd0ffcaae840b6a312d9f404ea44b697d97244ac82d4aa04c2 openAccess Faculté de médecine / Section de médecine clinique / Département de médecine

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Diagnostic challenges of central nervous system infection: extensive multiplex panels versus stepwise guided approach	Clinical microbiology and infection			2020	103	350

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Herrmann, Jil-Nora