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Comparison of cerebrospinal fluid results analysis against meningitis pathogens in meningitis patients

  • Magendi Indra Mukti ,
  • Aryati ,
  • Paulus Sugianto ,

Abstract

Introduction: Meningitis is a major contributor to global mortality and morbidity rates. The rapid diagnosis of its etiology is crucial. Cerebrospinal fluid (CSF) analysis plays a key role in this process. This study aims to compare CSF analysis results with the Biofire Filmarray ME panel to expedite and simplify the diagnosis of meningitis etiology.

Method: Using an observational analytical cross-sectional design, the study was conducted over 4 months. CSF samples were collected from multiple hospitals. The CSF analysis involved flow cytometry using Sysmex XN 1000 and Dimension EXL platforms. The Biofire Filmarray ME panel employed multiplex PCR technology.

Result: Of the 30 samples, 83.3% exhibited clear appearance, 93.3% lacked clots, and 83.3% were clear in color. Increased cell counts were noted in 56.7% of samples, elevated protein levels in 43.3%, and normal glucose levels in 56.7%. CSF analysis interpretations indicated 70% normal, 3.3% viral infection, and 26.7% bacterial infection. The Biofire Filmarray ME panel results showed 96.7% negatives and 3.3% positive for Cytomegalovirus. Comparing CSF analysis with Biofire Filmarray ME panel results using McNemar's test indicated significant differences. The study highlighted the quality assurance of CSF analysis, challenges of antibiotic use, low prevalence of pathogens detected by the Biofire Filmarray, and the potential for false negatives due to untargeted pathogens.

Conclusion: In conclusion, this study provides insights into CSF analysis and its comparison with the Biofire Filmarray ME panel. However, limitations include the Biofire Filmarray's inability to detect all pathogens and absence of certain data during CSF sampling. Further improvements are needed to enhance accuracy in meningitis diagnosis..

References

  1. Singhi S, Angurana SK. Principles of Management of Central Nervous System Infections. Indian J Pediatr. 2019; 86:52–59. doi.org/10.1007/s12098-017-2583-y
  2. WHO (World Health Organisation), 2021. Accessed on 29 april 2022. di www.who.int/news-room/fact-sheets/detail/meningitis
  3. Kementrian Kesehatan Republik Indonesia : Direktorat Jenderal Pencegahan dan Pengendalian Penyakit. 2019. Panduan Deteksi dan Respon Penyakit. Kemenkes RI : Jakarta
  4. Pires FR, Franco AC, Gilio AE, Troster EJ. Penggunaan skor dan dosis laktat cairan serebrospinal dalam diagnosis banding meningitis bakterial dan aseptik. Pendeta Paul Pediatr. 2017; 35 :369–374. doi:10.1590/1984-0462/2017;v35;4;00010
  5. Theilen U, Wilson L, Wilson G, Beattie JO, Qureshi S, Simpson D. Management of invasive meningococcal disease in children and young people: Summary of SIGN guidelines. BMJ (Clinical research ed.). 2008; 336(7657): 1367–70. doi:10.1136/bmj.a129. PMC 2427067 alt=Dapat diakses gratis. PMID 18556318
  6. Turchan A, Fahmi A, Kurniawan A, Bajamal AH, Fauzi A & Apriawan T. The change of serum and CSF BDNF level as a prognosis predictor in traumatic brain injury cases: A systematic review. Surgical Neurology International. 2022; 13. https://doi.org/10.25259/SNI_1245_2021
  7. Prakoso AB, Dewi MM, Sugianli AK. Gambaran Cairan Serebrospinal pada Pasien Anak dengan Infeksi Susunan Saraf Pusat di Rumah Sakit Rujukan Jawa Barat. Sari Pediatri, 2020; 21(6): 339-45.
  8. Hrishi AP, Sethuraman M. Cerebrospinal Fluid (CSF) Analysis and Interpretation in Neurocritical Care for Acute Neurological Conditions. Indian J Crit Care Med. 2019;23(Suppl 2):S115–S119
  9. Straus SE, Thorpe KE, Holroyd-Leduc J. How do I perform a lumbar puncture and analyze the results to diagnose bacterial meningitis?. Journal of the American Medical Association. 2006; 296(16): 2012–22. doi:10.1001/jama.296.16.2012. PMID 17062865
  10. Olevianingrum M, Yulistiani Y, Saharso D & Zairina N. C-Reactive Protein (Crp) As A Supporting Marker Of Antibiotic Effectiveness On Central Nervous System (Cns) Infections. Folia Medica Indonesiana. 2016; 51(3): 149–155. Https://Doi.Org/10.20473/Fmi.V51i3.2821
  11. Meisadona G, Soebroto AD, Estiasari R. Diagnosis dan Tatalaksana Meningitis Bakterialis. Departemen Neurologi FK Universitas Indonesia. Jakarta. 2015.
  12. Young Nicholas & Mark Thomas. Meningitis in adults: diagnosis and management. Internal Medicine Journal. (2018); 48: 1294–1307 https://doi.org/10.1111/imj.14102
  13. Kusumowardani AR, Gunawan PI, Kusumaningrum D, & Suryaningtyas W. Cerebrospinal fluid culture and analysis in paediatric patients with shunt infection. Sri Lanka Journal of Child Health, 2021; 50(3): 436-441. https://doi.org/10.4038/sljch.v50i3.9692
  14. Soucek DK, Dumkow LE, VanLangen KM, Jameson AP. Cost Justification of the Biofire Filmarray Meningitis/Encephalitis Panel Versus Standard of Care for Diagnosing Meningitis in a Community Hospital. Journal of Pharmacy Practice. 2019;32(1):36-40. doi:10.1177/0897190017737697
  15. Sze Hwei Lee, Shey-Ying Chen, Jung-Yien Chien, Tai-Fen Lee, Jong-Min Chen, Po-Ren Hsueh. Usefulness of the Filmarray meningitis/encephalitis (M/E) panel for the diagnosis of infectious meningitis and encephalitis in Taiwan. J Microbiol Immunol Infect. 2019; 52(5): 760-768. doi: 10.1016/j.jmii.2019.04.005
  16. Fleischer E, Aronson PL. Rapid Diagnostic Tests for Meningitis and Encephalitis-Biofire. Pediatr Emerg Care. 2020; 36(8): 397-401. doi: 10.1097/PEC.0000000000002180. PMID: 32740268; PMCID: PMC7703746
  17. Houlihan, catherine; bharucha, tehmina; breuer, judith. Advances in molecular diagnostic testing for central nervous system infections. Current Opinion in Infectious Diseases. 2019; 32(3): 244-250. doi: 10.1097/QCO.0000000000000548
  18. Ropper AHB, central nervous system infections. In: Ropper AH, Samucis MA, Klein JP, editors. Adamas and Victor’s: Principles of Neurology. New York: McGraw Hill; 2005. P. 631-59
  19. Leber AL, Everhart K, Balada-Llasat JM. Multicenter Evaluation of Biofire Filmarray Meningitis/Encephalitis Panel for Detection of Bacteria, Viruses, and Yeast in Cerebrospinal Fluid Specimens. J Clin Microbiol. 2016; 54(9): 2251-2261. doi:10.1128/JCM.00730-16
  20. Boudet, Agathe et al. A review of a 13-month period of Filmarray Meningitis/Encephalitis panel implementation as a first-line diagnosis tool at a university hospital. PloS one. 2019; 14(10). doi:10.1371/journal.pone.0223887
  21. Lee SH, Chen SY, Chien JY. Usefulness of the Filmarray meningitis/encephalitis (M/E) panel for the diagnosis of infectious meningitis and encephalitis in Taiwan. Journal of Microbiology, Immunology and Infection. 2019; 52(5): 760-768. https://doi.org/10.1016/j.jmii.2019.04.005
  22. Dallal AA, Dallal UA & Dallal JA. Positivity rate: an indicator for the spread of COVID-19, Current Medical Research and Opinion. 2021; 37(12): 2067-2076. DOI: 10.1080/03007995.2021.1980868
  23. Saputra IWAGM, Mertaniasih NM, & Fatmawati NND. Positivity of ExoU Gene of Type III Secretion System and Fluoroquinolone Resistance of Psedomonas aeruginosa from Sputum of Nosocomial Pneumonia Patients in Sanglah Hospital, Bali. Folia Medica Indonesiana, 2018; 54(2): 129–135. https://doi.org/10.20473/fmi.v54i2.8863
  24. Kapoor G, Saigal S, & Elongavan A. Action and resistance mechanisms of antibiotics: A guide for clinicians. Journal of anaesthesiology, clinical pharmacology. 2017; 33(3): 300–305. https://doi.org/10.4103/joacp.JOACP_349_15
  25. Giovane RA, Lavender PD. Central Nervous System Infections. Prim Care. 2018; 45(3): 505-518
  26. Ivanmorl Ruspanah, Yulius Hermanto, Yuniasih MJ Taihuttu, Andrew Ruspanah, Achmad Adam, Akhmad Imron. Implications of VP-Shunt, Sodium Level, Glucose Level Ratio and Neurologic Deficit as Clinical Outcome Prognostic Factor in Adult Meningitis Tuberculosis with Acute Hydrocephalus in Dr. Hasan Sadikin General Hospital. Bali Med J. [Internet]. 2022 Aug. 5 [cited 2023 Sep. 12];11(2):715-9. Available from: https://www.balimedicaljournal.org/index.php/bmj/article/view/3618
  27. Andaru Dahesihdewi, Girsang TS. Microbiology diagnostic approach in identifying Streptococcus pneumoniae: Case report of Streptococcal meningitis. Bali Med J. [Internet]. 2023 Feb. 20 [cited 2023 Sep. 12];12(1):788-92. Available from: https://www.balimedicaljournal.org/index.php/bmj/article/view/4164.
  28. Wirantara H, Rusli M, Arfijanto MV, Bramantono. Cryptococcal meningoencephalitis in an immunodeficiency virus positive patient coinfected with tuberculosis. Bali Med J. [Internet]. 2023 May 8 [cited 2023 Sep. 12];12(2):1490-6. Available from: https://www.balimedicaljournal.org/index.php/bmj/article/view/4180.

How to Cite

Mukti, M. I., Aryati, & Sugianto, P. . (2023). Comparison of cerebrospinal fluid results analysis against meningitis pathogens in meningitis patients. Bali Medical Journal, 12(3), 2752–2757. https://doi.org/10.15562/bmj.v12i3.4781

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