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  • Updated 05.02.2024
  • Released 08.26.2021
  • Expires For CME 05.02.2027

Diagnosis of CNS infections



CNS infections affect populations worldwide. Although relatively rare compared to other sites of infection, high morbidity, mortality, and long-term sequelae make many CNS infections a neurologic emergency requiring prompt diagnosis and rapid initiation of targeted antimicrobial treatment. The widespread use of molecular diagnostics incorporating multiplex nucleic acid amplification of common CNS pathogens, such as the FilmArray Meningitis/Encephalitis Panel (BioFire Diagnostics, Salt Lake City, UT), combined with emerging unbiased metagenomic sequencing, has immensely shortened the turnaround time for identification of the culprit organism and detection of rare or unexpected pathogens. Despite the promise these novel techniques offer, diagnosing CNS infections remains a challenge. A comprehensive approach should incorporate thorough history-taking, neurologic examination, knowledge of pathogens endemic to the area of interest, and formulation of a differential diagnosis supported by imaging studies, serology, and CSF analysis when feasible.

Key points

• CNS infections have high morbidity and mortality, which highlights the importance of an accurate and timely diagnosis.

• Diagnosing CNS infection requires a comprehensive approach that includes a detailed history and physical examination, CSF analysis when feasible, neuroimaging, and targeted microbial testing.

• It is important to recognize the strengths and weaknesses of available tests for CNS infections as well as the chosen source of specimen (CSF vs. serum vs. others) in order to choose the method most likely to yield an accurate result.

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