SHM Converge Scientific Abstract ePoster Gallery-Meningitis-Encephalitis Panel: Is a Shotgun Approach Warranted?

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This study evaluated whether the BioFire FilmArray meningitis-encephalitis (ME) panel is necessary in immunocompetent patients when cerebrospinal fluid (CSF) white blood cell count is normal (5 cells/mm³ or less). The test is expensive, widely ordered automatically, and can produce false positives.<br /><br />Researchers reviewed 1,759 ME panels sent between 2017 and 2020. They focused on the 100 positive ME panels, especially the 22 cases with positive ME panel results but normal CSF WBC counts. Among these, many positives occurred in immunocompromised patients and included clinically important infections such as Cryptococcus, VZV, and CMV. However, 10 cases were HHV-6 positives and were not clinically significant or treated. In immunocompetent patients, there were 5 true-positive cases despite normal CSF WBC: enterovirus, HSV-2, and several VZV cases.<br /><br />The authors concluded that limiting ME panel testing to immunocompetent patients with CSF WBC >5 cells/mm³ would have detected 80 of 85 positive results (95%), while avoiding 10 likely false-positive HHV-6 results. However, this strategy would have missed 5 true viral detections. Overall, the findings suggest that CSF WBC count may be a useful screening tool in low-risk immunocompetent patients, but more research is needed before ME panel testing can safely be reduced. If validated, this approach could substantially lower costs.

Asset Subtitle

Jack Badawy

Meta Tag

Author List Anthony Hartzler, Jack Badawy, John Michael Austin, Saket Kottewar

Category Research

Concept Infectious Meningoencephalitis

Concept Cell Count

Concept False Positive

Concept Meningoencephalitis

Concept Diagnostic Performance

Distinguished Non-Finalist

Presenter Organization UT Health San Antonio

Presenting Author Jack Badawy

Track Outcomes Research

Keywords

BioFire FilmArray

meningitis-encephalitis panel

cerebrospinal fluid

white blood cell count

immunocompetent patients

false positives

HHV-6

viral infections

enterovirus

HSV-2

Infectious Meningoencephalitis

Cell Count

False Positive

Meningoencephalitis

Diagnostic Performance