Assessment of the FilmArray ME panel in 4199 consecutively tested cerebrospinal fluid samples

Johan Lindström; Kristina Elfving; Magnus Lindh; Johan Westin; Marie Studahl

doi:10.1016/j.cmi.2021.05.017

Assessment of the FilmArray ME panel in 4199 consecutively tested cerebrospinal fluid samples

Clin Microbiol Infect. 2022 Jan;28(1):79-84. doi: 10.1016/j.cmi.2021.05.017. Epub 2021 May 17.

Authors

Johan Lindström¹, Kristina Elfving², Magnus Lindh³, Johan Westin⁴, Marie Studahl⁴

Affiliations

¹ Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden; Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden. Electronic address: johan.lindstrom@gu.se.
² Institute of Medicine, Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Paediatrics, Gothenburg, Sweden.
³ Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Microbiology, Gothenburg, Sweden.
⁴ Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden; Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden.

PMID: 34015534
DOI: 10.1016/j.cmi.2021.05.017

Abstract

Objectives: In central nervous system infections, early and correct management is of utmost importance. Rapid syndromic panel testing can potentially provide valuable guidance. The FilmArray meningitis/encephalitis (ME) panel detects 14 pathogens through multiplex PCR. Our study objectives were to assess its performance compared with established diagnostic procedures, especially real-time quantitative PCR for detection of viruses, and to determine the diagnostic and clinical significance of discrepant results.

Methods: All cerebrospinal fluid samples sent for viral diagnostics to our microbiological laboratory over 34 months were analysed with the ME panel and in-house real-time PCR for herpes simplex virus type 1 (HSV-1), HSV-2, varicella zoster virus and enteroviruses. Other pathogens detected by the panel were confirmed by routine diagnostic procedures. Discrepant results were analysed through interpretation of biological and clinical data, and performance data were calculated for individual pathogens.

Results: Altogether, 315 pathogens were detected by the ME panel in 4199 cerebrospinal fluid samples (7.5%) and an additional 21 viral targets were identified using real-time PCR. Thirty-four ME panel detections were not confirmed, totalling 55 discrepant results. After discrepancy analysis, 20 false-positive and 21 false-negative ME panel results remained. Performance varied between pathogens. Sensitivity for HSV-1 was calculated at 82.4% (59.0%-93.8%) with three false-negative results. Also noteworthy were 13 false-negative enterovirus and eight false-positive Streptococcus pneumoniae results.

Conclusions: Our analysis shows good performance for the ME panel in diagnosing central nervous system infection. The risk of false-negative HSV-1 results, however, warrants additional testing when encephalitis is suspected. Uncertainties in interpretation of enterovirus and S. pneumoniae results represent other limitations.

Keywords: Encephalitis; FilmArray; Meningitis; Multiplex PCR; Syndromic testing.

MeSH terms

Central Nervous System Infections* / cerebrospinal fluid
Central Nervous System Infections* / diagnosis
Cerebrospinal Fluid
Encephalitis* / cerebrospinal fluid
Encephalitis* / diagnosis
Enterovirus Infections / diagnosis
Humans
Meningitis* / cerebrospinal fluid
Meningitis* / diagnosis
Multiplex Polymerase Chain Reaction
Viruses* / genetics
Viruses* / isolation & purification