DIAGNOSTIC VALUE OF MULTIPLEX PCR IN DIFFERENTIATING BACTERIAL VS VIRAL MENINGITIS

Abstract

Background: Rapid differentiation between bacterial and viral meningitis is critical for timely treatment and improved clinical outcomes. Traditional diagnostic methods such as cerebrospinal fluid (CSF) culture are time-consuming and often yield limited sensitivity, especially post-antibiotic initiation. Multiplex polymerase chain reaction (PCR) has emerged as a promising diagnostic tool, offering rapid, sensitive pathogen detection in acute care settings.

Objective: To assess the sensitivity and specificity of multiplex PCR in identifying bacterial and viral meningitis etiologies in acute clinical settings.

Methods: A diagnostic accuracy study was conducted over seven months in a tertiary hospital, enrolling 323 patients presenting with clinical signs of meningitis. Inclusion required lumbar puncture within 24 hours of presentation. CSF samples were analyzed using both conventional methods and a multiplex PCR panel targeting common bacterial and viral pathogens. Diagnostic performance metrics including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.

Results: Multiplex PCR detected bacterial pathogens in 38.1% and viral pathogens in 33.7% of cases. Compared to culture, PCR showed higher yield and faster turnaround time (mean 1.8 hours vs. 48 hours). The test demonstrated a sensitivity of 92.4%, specificity of 95.1%, PPV of 90.2%, and NPV of 96.3%. The strongest agreement with reference standards was observed in Streptococcus pneumoniae and enterovirus detections.

Conclusion: Multiplex PCR is a reliable, rapid diagnostic tool for distinguishing bacterial from viral meningitis. Its integration into routine practice may enhance early management decisions, minimize unnecessary antibiotic use, and improve patient outcomes.