Infections of the central nervous system (CNS) can result from numerous pathogens. Timely and effective treatment is crucial and potentially life-saving. Hence, a technique capable of simultaneously detecting multiple pathogens is necessary, as opposed to traditional time-consuming methods.

Aim of the study

Our main objective is to analyse the microbiological pathogens causing the primary CNS infections as well as the secondary CNS trauma infection that were detected by using the Multiplex real-time PCR (MLP rPCR) targeted these finding pathogens.

Figure 1: The ^MENINGICHECKMPL-rPCR used in this study to detect most of the pathogens causing central nervous system infection fom the CSF.

Results

From 2021 to 2023, 1089 CSF samples were obtained from patients with symtoms suggestive of CNS infections, including 754 adults and 335 children. The overall detection rate was 16.0% (174/1089). The pathogens were identified in 15.5% of adults (117/754), and 17.0% of children (57/335), involving both primary and traumatic pathogens. Regarding primary agents, 35.6% (62/174) were bacteria, 7.5% (13/174) were parasites, 39.7% (69/174) were viruses and 4% (7/174) were fungi. S. pneumoniae was predomiant among the bacterial pathogens (15 cases, 12 in adults and 3 in children), followed by E. coli (11 in children). Other identifed bacteria included S. suis, A. israelii, Salmonella, N. asterioides, M. tuberculosis,… The N. meningitidis was found in only 2 pediatric cases, and S. pyogenes and S. agalactiae were each found in 1 adult case. Among the viral agents, the most prevalent were Varicella-Zoster virus (20, with 19 in adults and 1 in a child) and HSV1 (16, with 11 in adults and 5 in children). Other viruses such as EBV, HSV2, HHV6, JVC, Mumps, Influenza A, Parvovirus B19,… were also detected. Fungal pathogens (7 cases) included 5 C. neoformans and 2 Coccidioides immitis, all in adults. Parasitic agents (13 cases) involved 9 cases of A.cantonensis (5 in children and 4 in adults), 2 cases of A. keratitis in adults, 1 case of B. mandrillaris in adults, and 1 case of T. solium, also in adults. Trauma-relaed pathogens identified 10.3% (18/174) bacteria, and 3.4% (6/174) fungi. 6 cases of fungal infection included 2 C. albicans (in children) and 4 R. oryzae (3 adults and 1 child). 18 cases of bacteria were identified, including 10 cases of E. coli (only in adults), 3 cases of K. pneumoniae (only in adults), 2 cases of Methicillin-resistant coagulase-negative Staphylococci (only in children), 1 case of A. baumannii (in children), 1 S. viridans, 1 E. faecium, and 1 E. aerogenes (only in adults).

Table 1: The rate of bacteria/virus/parasite/fungi detected from 1089 CSF samples collected from the patients

Table 2: The rate of bacterial pathogens detected from 1089 CSF samples collected from the patients

Table 3: The rate of viral pathogens detected from 1089 CSF samples collected from the patients

Table 4: The rate of fungal and parasitic pathogens detected from 1089 CSF samples collected from the patients

Conclusions

Our findings offer a comprehensive overview of the diverse pathogens contributing to CNS infections in both primary and trauma-related contexts. The rapid, accurate and cost-effective nature of MLP rPCR positions it as an ideal diagnostic tool for identifying CNS infection pathogens, facilitating prompt and targeted treatment strategies.