PMID- 31852767
OWN - NLM
STAT- MEDLINE
DCOM- 20210531
LR  - 20210531
IS  - 1098-660X (Electronic)
IS  - 0095-1137 (Print)
IS  - 0095-1137 (Linking)
VI  - 58
IP  - 3
DP  - 2020 Feb 24
TI  - Cerebrospinal Fluid Findings Are Poor Predictors of Appropriate FilmArray 
      Meningitis/Encephalitis Panel Utilization in Pediatric Patients.
LID - 10.1128/JCM.01592-19 [doi]
LID - e01592-19
AB  - Molecular testing of cerebrospinal fluid (CSF) using the BioFire FilmArray 
      meningitis/encephalitis (FA-M/E) panel permits rapid, simultaneous pathogen 
      detection. Due to the broad spectrum of targeted organisms, FA-M/E testing may be 
      restricted to patients with abnormal CSF findings. We sought to determine if 
      restriction is appropriate in our previously healthy and/or immunocompromised 
      pediatric patients. FA-M/E was ordered on 1,025 CSF samples from 948 patients; 
      121 (11.8%) specimens were FA-M/E positive. Of these, 89 (73.6%) were virus 
      positive, and 30 (24.8%) were bacterium positive. The most common targets 
      detected were enterovirus (n = 38), human herpesvirus 6 (HHV-6) (n = 30), and 
      Streptococcus pneumoniae (n = 14). Pleocytosis with white blood cell (WBC) levels 
      of >/=5 cells/mm(3) and >/=10 cells/mm(3) were found in 33.1% and 24.3% of all 
      specimens, respectively. Using WBC levels of >/=5 cells/mm(3), 63.4% (59/93) of 
      positive specimens exhibited pleocytosis, compared to 29.5% (233/789) of negative 
      specimens. Among positive specimens, 54.4% (37/68) of viral and 87% (20/23) of 
      bacterial cases had pleocytosis. The use of a pleocytosis cutoff of 
      >/=10 cells/mm(3) would have missed an additional enterovirus, one cytomegalovirus 
      (CMV), and two HHV-6 diagnoses. CSF glucose and protein levels were normal for 
      83/116 (75.2%) and 51/116 (44%) positive specimens. Abnormal glucose in 
      combination with WBC levels of >/=10 cells/mm(3) showed high specificity (94.5%) 
      and was a better predictor of FA-M/E positivity than abnormal protein. 
      Sensitivity and positive predictive values were <90% for all biomarkers. CSF 
      pleocytosis and abnormal glucose/protein were poor predictors of FA-M/E. 
      Restricting FA-M/E orders based on pleocytosis or other abnormal parameters would 
      have resulted in missed diagnostic opportunities, particularly for the detection 
      of viruses in both previously healthy and immunocompromised patients.
CI  - Copyright (c) 2020 American Society for Microbiology.
FAU - Precit, Mimi R
AU  - Precit MR
AUID- ORCID: 0000-0002-0720-8643
AD  - Department of Pathology and Laboratory Medicine, Children's Hospital of Los 
      Angeles, Los Angeles, California, USA.
FAU - Yee, Rebecca
AU  - Yee R
AD  - Department of Pathology and Laboratory Medicine, Children's Hospital of Los 
      Angeles, Los Angeles, California, USA.
FAU - Pandey, Utsav
AU  - Pandey U
AD  - Department of Pathology and Laboratory Medicine, Children's Hospital of Los 
      Angeles, Los Angeles, California, USA.
FAU - Fahit, Margil
AU  - Fahit M
AD  - Department of Pathology and Laboratory Medicine, Children's Hospital of Los 
      Angeles, Los Angeles, California, USA.
FAU - Pool, Cheryl
AU  - Pool C
AD  - Department of Pathology and Laboratory Medicine, Children's Hospital of Los 
      Angeles, Los Angeles, California, USA.
FAU - Naccache, Samia N
AU  - Naccache SN
AD  - LabCorp Diagnostic Laboratories, Seattle, Washington, USA.
FAU - Dien Bard, Jennifer
AU  - Dien Bard J
AD  - Department of Pathology and Laboratory Medicine, Children's Hospital of Los 
      Angeles, Los Angeles, California, USA jdienbard@chla.usc.edu.
AD  - Keck School of Medicine, University of Southern California, Los Angeles, 
      California, USA.
LA  - eng
PT  - Journal Article
DEP - 20200224
PL  - United States
TA  - J Clin Microbiol
JT  - Journal of clinical microbiology
JID - 7505564
SB  - IM
MH  - Bacteria
MH  - Cerebrospinal Fluid
MH  - Child
MH  - *Encephalitis/microbiology/virology
MH  - Female
MH  - Humans
MH  - Male
MH  - *Meningitis/microbiology/virology
MH  - Molecular Diagnostic Techniques
MH  - *Viruses
PMC - PMC7041564
OTO - NOTNLM
OT  - CSF parameters
OT  - encephalitis
OT  - meningitis
OT  - molecular
OT  - pediatric
EDAT- 2019/12/20 06:00
MHDA- 2021/06/01 06:00
PMCR- 2020/08/24
CRDT- 2019/12/20 06:00
PHST- 2019/09/24 00:00 [received]
PHST- 2019/12/17 00:00 [accepted]
PHST- 2019/12/20 06:00 [pubmed]
PHST- 2021/06/01 06:00 [medline]
PHST- 2019/12/20 06:00 [entrez]
PHST- 2020/08/24 00:00 [pmc-release]
AID - JCM.01592-19 [pii]
AID - 01592-19 [pii]
AID - 10.1128/JCM.01592-19 [doi]
PST - epublish
SO  - J Clin Microbiol. 2020 Feb 24;58(3):e01592-19. doi: 10.1128/JCM.01592-19. Print 
      2020 Feb 24.