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New Test for Viral Meningitis

This rapid test could minimize treatment delays.

In March 2007, the FDA approved a rapid test to help distinguish between viral and bacterial meningitis. The Xpert EV test is a fully automated assay that provides results in about 2.5 hours. The test employs a disposable single-use cartridge to test cerebrospinal fluid (CSF) for enterovirus by reverse transcription-polymerase chain reaction. Enteroviruses cause about 90% of viral meningitis cases. The test approval rested on results of a multisite study in 255 patients showing that 96% of patients who tested positive had viral meningitis and 97% of patients who tested negative did not have viral meningitis.

Comment: Early differentiation between viral and bacterial meningitis could decrease hospitalizations, medical costs, and unnecessary antibiotic exposure in thousands of children each year. Currently, culture is the gold standard for diagnosing bacterial meningitis and requires a 2- to 3-day incubation period. Many children with enteroviral meningitis are hospitalized while awaiting test results. Early in the course of viral meningitis, CSF parameters can show white blood cell pleocytosis with polymorphonuclear cells; the CSF lymphocytic predominance occurs later. When used in conjunction with standard CSF testing, the new test allows clinicians to positively identify enteroviral central nervous system infection and to avoid hospitalizing patients while awaiting culture results. All pediatricians should encourage their local labs to make this test available 7 days a week.

— Peggy Sue Weintrub, MD

Published in Journal Watch Pediatrics and Adolescent Medicine April 25, 2007

Citation(s):

U.S. Food and Drug Administration. FDA clears rapid test for meningitis. 2007 Mar 16; P07-46. (http://www.fda.gov/bbs/topics/NEWS/2007/NEW01588.html)