Lab Med Online.  2023 Jul;13(3):237-245. 10.47429/lmo.2023.13.3.237.

Assessment of the Impact of COVID-19 Pandemic on Central Nervous System Infections Using FilmArray Meningitis/Encephalitis Panel and the Clinical Significance of Human Herpesvirus-6 Detection in Cerebrospinal Fluid

• Ji E
• Park SE
• Oh SH
• Chang CL
• Lee YJ
• Kim IS

• KMID: 2552749
• DOI: http://doi.org/10.47429/lmo.2023.13.3.237

Abstract

Background
We aimed to determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on central nervous system (CNS) infections by comparing FilmArray Meningitis/Encephalitis (ME) panel (BioFire Diagnostics, USA) data before and during the pandemic, and the clinical significance of detecting human herpesvirus 6 (HHV-6) in ME panel.
Methods
The positive rate and distribution of ME panel results were compared at a tertiary care hospital during pre-pandemic (P1: January 17, 2018 to August 31, 2018) and pandemic (P2: April 9, 2021 to December 21, 2021) periods. Clinical evaluations were performed in patients positive for HHV-6, and HHV-6 quantitative PCR (qPCR) was performed only on patients with samples available.
Results
The total positive rate of the ME panel markedly decreased from 28.9% (125/432) in P1 to 7.3% (15/205) in P2 (P < 0.05). The positive rates of enterovirus and human parechovirus also decreased significantly, from 15.3% to 0.0%, and from 5.3% to 0.0%, respectively (P <0.05). The most common pathogens identified were enterovirus (52.8%) in P1 and HHV-6 (46.7%) in P2. The detection of HHV-6 in the ME panel was clinically inconsistent with HHV-6 CNS infection in most cases. Only one patient, transplant recipient of hematopoietic stem cell, was positive for qPCR on cerebrospinal fluid and blood, likely to have HHV-6 CNS infection.
Conclusions
The positive rates of the ME panel decreased during the COVID-19 pandemic, likely due to nonpharmaceutical interventions implemented worldwide. The detection of HHV-6 in the ME panel should be interpreted with caution, and additional qPCR can be helpful.

Keyword

Human herpesvirus 6; Multiplex PCR; Central nervous system infection; Viral infections; Coronavirus disease 2019; Nonpharmaceutical intervention

Figure

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  Fig. 1 Distribution of pathogens detected in the ME panel in the pre-pandemic (P1) and pandemic (P2) periods. Haemophilus influenzae, Listeria monocytogenes, and Neisseria meningitidis are not displayed in the figure as they were not detected in both periods.

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