Infections of the central nervous system (CNS) such as meningitis or encephalitis can be caused by myriad microorganisms and may be life-threatening. Patients with acute CNS infections generally present with similar findings of fever, headache, and neurological changes. Given the similarity in symptomology, it is often difficult to distinguish bacterial and viral infection based on clinical presentation alone. As a result, obtaining a rapid and accurate diagnosis is important for proper patient management. Indeed, rapid identification of CNS pathogens is critical for antimicrobial treatment in cases of bacterial or herpes simplex virus (HSV) infection. Any delays in appropriate therapy can lead to poor patient outcomes, including death.
The aim of this Continuing Education article is to review the current landscape for diagnostic testing of cerebrospinal fluid (CSF) in acute CNS infections, present the potential impact of rapid identification, and discuss methods to increase the diagnostic yield in uncertain cases. It is anticipated that new technologies will aid in providing rapid and accurate pathogen identification, potentially leading to better patient outcomes, improved antimicrobial stewardship, and decreased hospital costs.