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
