To evaluate the performance of CSF BioFire Film Array Meningitis/ Encephalitis panel in patients presenting with meningoencephalitis at a tertiary care hospital in New Delhi, India.

CSF microbial analysis, an important part of evaluation of meningoencephalitis, consists of gram and ZN staining, india ink preparation, serology and culture. This requires large volume sampling, consumes precious time (many hours to days) and may lack sensitivity/specificity for certain pathogens. Biofire Film Array ME panel requires very small volume sample, is  rapid (1-1.5 hours) and detects 14 pathogens directly from CSF specimens by PCR amplification technique including Escherichia coli K1, Hemophilus influenzae, Listeria monocytogenes, Neisseria meningitidis, Streptococcus agalactiae, Streptococcus pneumoniae, Cytomegalovirus, Enterovirus, HSV1, HSV2, HHV6, VZV, Human parechovirus, cryptococcus neoformans/gattii.

256 consecutive cases of meningo-encephalitis underwent CSF Biofire (ME) panel testing. These cases were selected from April 2017 to August 2018 at Sir Gangaram Hospital, New Delhi, India.

Total detection rate with ME BioFire panel was only 8.2% (20 cases including 1 case of coinfection, thus making 21 isolates). Viral detection rate was 71.4% followed by Bacterial (19%) and fungal (9.5%). Most common bacterial infection detected was Streptococcus pneumoniae. Most common viruses detected were Cytomegalovirus, Enterovirus and Varicella (3 cases each). 2 samples tested cryptococcal antigen positive, but were Biofire ME panel negative. Mortality was seen in 2 cases (one case of listerial infection and one case of coinfection of Streptococcus pneumonia with HHV 6).

Biofire FA is a novel, unique, rapid, reliable, round the clock available, easy to perform (technician handled), testing of broad range of common CNS infections. Its use will help early diagnosis, prompt treatment of patients with meningo-encephalitis, aid antimicrobial stewardship and result in improved patient outcome. It has some drawbacks in the form of expense, low detection rate and does not test for mycobacteria and arboviruses.