Observational studyEpidemiology and infection2016
Epidemiology of meningitis with a negative CSF Gram stain: under-utilization of available diagnostic tests.
Observational study in Epidemiology and infection, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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The trial behind it
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Who cites it
18 citing papers in PubMed, 44 citations in OpenAlex.
- A Machine Learning Approach for Identifying People With Neuroinfectious Diseases in Electronic Health Records: Algorithm Development and Validation.JMIR medical informatics · 2025Article
- Exploring the Utility of Multiplex Infectious Disease Panel Testing for Diagnosis of Infection in Different Body Sites: A Joint Report of the Association for Molecular Pathology, American Society for Microbiology, Infectious Diseases Society of America, and Pan American Society for Clinical Virology.The Journal of molecular diagnostics : JMD · 2023Review
- RNA-sequencing-based detection of human viral pathogens in cerebrospinal fluid and serum samples from children with meningitis and encephalitis.Microbial genomics · 2023Article
- A Multicenter Epidemiological and Pathogenic Characteristics Study of Community-Acquired Bacterial Meningitis Children in China: Results from the Chinese Pediatric Bacterial Meningitis Surveillance (CPBMS) 2019-2020.Infection and drug resistance · 2023Article
- Turnaround times for molecular testing of pediatric viral cerebrospinal fluid samples in United Kingdom laboratories.World journal of clinical pediatrics · 2022Article
- Cognitive decline following acute viral infections: literature review and projections for post-COVID-19.European archives of psychiatry and clinical neuroscience · 2022Review
- Clinical Performance of FilmArray Meningitis/Encephalitis Multiplex Polymerase Chain Reaction Panel in Central Nervous System Infections.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2022Article
- Enhanced Virus Detection and Metagenomic Sequencing in Patients with Meningitis and Encephalitis.mBio · 2021Article
- Arbovirus, herpesvirus, and enterovirus associated with neurological syndromes in adult patients of a university hospital, 2017-2018.Revista da Sociedade Brasileira de Medicina Tropical · 2021Article
- The diagnostic utility of the "Thwaites' system" and "lancet consensus scoring system" in tuberculous vs. non-tuberculous subacute and chronic meningitis: multicenter analysis of 395 adult patients.BMC infectious diseases · 2020Article
- [Meningitis/Encephalitis diagnosis in ICU using Multiplex PCR system: Is it time of change?]Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2019Observational
- Epidemiology of Meningitis in Oman-Implications for Future Surveillance.Journal of epidemiology and global health · 2018Article
- Article
- CSF in acute and chronic infectious diseases.Handbook of clinical neurology · 2017Review
- Article
- State-of-the-Art Microbiologic Testing for Community-Acquired Meningitis and Encephalitis.Journal of clinical microbiology · 2016Review
- Enhancing pathogen identification in patients with meningitis and a negative Gram stain using the BioFire FilmArray(®) Meningitis/Encephalitis panel.Annals of clinical microbiology and antimicrobials · 2016Article
- Simultaneous genital ulcer and meningitis: a case of EBV infection.Autopsy & case reportsArticle
Corrections and comments
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Authors and funding
8 authors at 6 institutions in 2 countries.
Funding
Abstract
Meningitis with a negative cerebrospinal fluid Gram stain (CSF-GS) poses a diagnostic challenge as more than 50% of patients remain without an aetiology. The introduction of polymerase chain reaction (PCR) and arboviral serologies have increased diagnostic capabilities, yet large scale epidemiological studies evaluating their use in clinical practice are lacking. We conducted a prospective observational study in New Orleans between November 1999 and September 2008 (early era) when PCR was not widely available, and in Houston between November 2008 and June 2013 (modern era), when PCR was commonly used. Patients presenting with meningitis and negative CSF-GS were followed for 4 weeks. All investigations, PCR used, and results were recorded as they became available. In 323 patients enrolled, PCR provided the highest diagnostic yield (24·2%) but was ordered for 128 (39·6%) patients; followed by serology for arboviruses (15%) that was ordered for 100 (31%) of all patients. The yield of blood cultures was (10·3%) and that of CSF cultures was 4%; the yield for all other tests was <10%. Overall, 65% of the patients remained without a diagnosis at 4 weeks: 72·1% in early era vs. 53·4% (P < 0·01) in modern era; this change was attributed to diagnosing more viral pathogens, 8·3% and 26·3% (P < 0·01), respectively. The introduction of PCR and arboviral serologies has improved the yield of diagnosing patients with meningitis and a negative CSF-GS, but both tests are being under-utilized.
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