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Semin Neurol 2019; 39(03): 297-311
DOI: 10.1055/s-0039-1688441
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Diagnostic Testing in Central Nervous System Infection

Sanjat Kanjilal
1   Division of Infectious Diseases, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
2   Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
,
Tracey A. Cho
3   Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
,
Anne Piantadosi 
2   Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
› Author Affiliations
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Publication History

Publication Date:
02 August 2019 (online)

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Abstract

Patients with central nervous system (CNS) infection experience very high levels of morbidity and mortality, in part because of the many challenges inherent to the diagnosis of CNS infection and identification of a causative pathogen. The clinical presentation of CNS infection is nonspecific, so clinicians must often order and interpret many diagnostic tests in parallel. This can be a daunting task given the large number of potential pathogens and the availability of different testing modalities. Here, we review traditional diagnostic techniques including Gram stain and culture, serology, and polymerase chain reaction (PCR). We highlight which of these are recommended for the pathogens most commonly tested among U.S. patients with suspected CNS infection. Finally, we describe the newer broad-range diagnostic approaches, multiplex PCR and metagenomic sequencing, which are increasingly used in clinical practice.

Keywords

meningitis - encephalitis - diagnostic - metagenomic sequencing
 

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