Photo Credit: libre de droit

The following is a summary of “Exploring the appropriate situation of performing CSF mNGS in patients with proposed intracranial infections,” published in the November 2024 issue of Neurology by Deng et al.  

Identifying pathogens is key for precision medicine in intracranial infections, with cerebrospinal fluid (CSF) metagenomic next-generation sequencing (mNGS) offering reliable detection, though overuse may lead to unnecessary costs.  

Researchers conducted a retrospective study to investigate the optimal conditions for using CSF mNGS in patients with suspected intracranial infections.  

They analyzed 175 hospitalized patients with suspected intracranial infections. Patients were categorized into 2 groups based on pathogen detection using CSF mNGS. Group A had detected pathogens, while Group B did not. Demographic, clinical, CSF analysis, imaging, and electroencephalography (EEG) data were reviewed. A scoring system was created to evaluate the appropriateness of CSF mNGS use, with a score of ≥ 2 indicating recommended use.  

The results showed that in Group A, the most common pathogen detected was varicella-zoster virus (VZV), while Group B had a high proportion of final diagnoses of epilepsy. Logistic regression revealed that headache [OR = 2.982, 95% CI (1.204–7.383), P=0.018], increased CSF white cell count [OR = 4.022, 95% CI (1.331–12.156), P=0.014], and decreased CSF glucose levels [OR = 9.006, 95% CI (2.778–29.194), P<0.001] were independent predictive factors for detecting intracranial infection pathogens by CSF mNGS. The scoring system achieved a sensitivity of 57.5% and a specificity of 87.4%.  

They concluded that the scoring system could help assess the likelihood of pathogen detection by CSF mNGS in patients with suspected intracranial infections, highlighting the importance of considering alternative diagnoses when no pathogen was detected.  

Source: bmcneurol.biomedcentral.com/articles/10.1186/s12883-024-03925-4