Santosh Karade

Meningoencephalitis is a severe condition requiring rapid and accurate diagnosis for effective management. Traditional culture methods often fail to detect certain pathogens, leading to delayed treatment. This study was conceptualized with an aim to assess the BioFire FilmArray Meningitis/Encephalitis (ME) Panel as a first-line diagnostic tool. A total of 147 patients (91 males and 56 females) with suspected meningoencephalitis were included. Cerebrospinal fluid (CSF) samples were analyzed using the FilmArray ME Panel and results were compared with traditional culture methods. The BioFire FilmArray ME Panel detected pathogens in 14 out of 147 CSF samples, yielding a positivity rate of 9.52%. Detected pathogens included Cytomegalovirus (03), Streptococcus pneumoniae (03), HSV1 (02), E. coli K1 (01), Enterovirus (01), Haemophilus influenzae (01), HHV6 (01), Parechovirus (01), and Varicella Zoster Virus (01). In contrast, traditional culture methods detected pathogens in only 7 cases, highlighting the panel’s superior sensitivity and underscoring the limitations of traditional methods. The ME Panel’s ability to deliver accurate results from just 200 microliters of CSF and the rapid turnaround time of just 1 hour highlights its efficiency in providing critical diagnostic information from small sample volumes. The study also assessed the impact of CSF volume, with nearly one-third of samples being 0.5 mL, noting that the panel requires only 200 microliters to provide comprehensive results. The BioFire FilmArray ME Panel significantly outperformed traditional culture methods in detecting a wide range of pathogens in CSF samples, even with minimal sample volume. Its rapid and accurate diagnostics improve early diagnosis and patient management in meningoencephalitis, supporting its integration into routine clinical practice.

The free antiretroviral therapy (ART) program in India still relies on the clinico-immunological monitoring for diagnosis of treatment failure. As the nucleoside reverse transcriptase inhibitor (NRTI) backbone is shared in first- and second-line regimens, accumulation of drug resistant mutations (DRMs) can compromise the efficacy of NRTI. This study was undertaken to describe the pattern of HIV DRMs following immunological monitoring and investigate its impact on the cycling of NRTI between first- and second-line ART. This cross-sectional study was performed at a state-sponsored ART clinic of Pune city in western India between January and June 2016. Consecutive adults receiving first-line ART with immunological failure (IF) were recruited for plasma viral load (PVL) estimation. Randomly selected 80 participants with PVL >1000 copies/mL underwent HIV drug resistance genotyping. Of these, 75 plasma sample were successfully genotyped. The median CD4 count and duration of ART at the time of failure were 98 (IQR: 61.60–153.50) cells/μL and 4.62 (IQR: 3.17–6.15) years, respectively. The prevalence of NRTI, non-NRTI, and major protease inhibitor resistance mutations were 89.30%, 96%, and 1.33%, respectively. Following first-line failure, sequences from 56.67% of individuals indicated low- to high-level resistance to all available NRTI. The proportion of sequences with ≥2 thymidine analogue mutations (TAMs) and ≥3 TAMs were 62.12% and 39.39%, respectively. An average of 1.98 TAMs per sequence were observed following IF as compared to 0.37 TAMs per sequence following targeted PVL monitoring at 12 months of ART from a prior study; this difference was significant (p<0.001). The option of cycling of NRTI analogues between first- and second-line regimens would no longer be effective if individuals are followed-up by immunological monitoring due to accumulation of mutations. Introduction of routine PVL monitoring is a priority for the long-term sustainability of free ART program in India.