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Cited by 28Bacterial Infections and VaccinesBacterial Identification and Susceptibility TestingInfectious Encephalopathies and Encephalitis

Distinguishing community-acquired bacterial and viral meningitis: Microbes and biomarkers

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Ivaska, Lauri, Herberg, Jethro, Sadarangani, Manish·2024·Journal of Infection
DOI 10.1016/j.jinf.2024.01.010
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Abstract

Diagnostic tools to differentiate between community-acquired bacterial and viral meningitis are essential to target the potentially lifesaving antibiotic treatment to those at greatest risk and concurrently spare patients with viral meningitis from the disadvantages of antibiotics. In addition, excluding bacterial meningitis and thus decreasing antibiotic consumption would be important to help reduce antimicrobial resistance and healthcare expenses. The available diagnostic laboratory tests for differentiating bacterial and viral meningitis can be divided microbiological pathogen-focussed methods and biomarkers of the host response. Bacterial culture-independent microbiological methods, such as highly multiplexed nucleic acid amplification tests, are rapidly making their way into the clinical practice. At the same time, more conventional host protein biomarkers, such as procalcitonin and C-reactive protein, are supplemented by newer proteomic and transcriptomic signatures. This review aims to summarise the current state and the recent advances in diagnostic methods to differentiate bacterial from viral meningitis.

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  • PCR is considered the gold standard test for viral meningitis detection and detects viral nucleic acid with the highest sensitivity.

    “but, PCR is considered as the gold standard test for viral meningitis detection. It detects viral nucleic acid with the highest sensitivity rates [1, 2].”

    From Herpetic viral dominance in pediatric meningitis and meningoencephalitis (2026) · cites this paper as [2]

    The Pathogen-specific NAATs section (page not provided) calls nucleic acid amplification tests the mainstay of enterovirus diagnosis because they are more clinically sensitive than viral culture, and calls PCR the method of choice for parechovirus infections. It does not designate PCR the gold standard for all viral meningitis or establish that it has the highest sensitivity across tests; it also cautions that some commercial assays lack sufficient sensitivity. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

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Cited by

Sorted by citations

Authors
Ivaska, L., Herberg, J., & Sadarangani, M.
Affiliations
  • University of Turku (FI)
  • Imperial College London (GB)
  • University of British Columbia (CA)
Corresponding author
  • Ivaska, Lauri
  • Herberg, Jethro
  • Sadarangani, Manish
ORCID
Venue
Journal of Infection
Publisher
Elsevier BV
Published
2024-03
Volume
88
Issue
3
Pages
106111
ISSN
0163-4453 (ISSN-L)
DOI
10.1016/j.jinf.2024.01.010
OpenAlex
W4391426101
Cited by
28
References
23
Citations by year
2026: 17 · 2025: 7 · 2024: 4
FWCI
1.44
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Infection (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • UTUPub (University of Turku) (submittedVersion)
Funders
  • Turun Yliopistollinen Keskussairaala
  • Children's Hospital Foundation
  • BC Children’s Hospital Foundation
  • Lastentautien Tutkimussäätiö
  • Turun Yliopisto
  • Michael Smith Health Research BC
Topics
  • Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
  • Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
Keywords
bacterial meningitis, viral meningitis, differential diagnosis, community-acquired meningitis, procalcitonin, C-reactive protein, host response biomarkers, nucleic acid amplification tests, proteomic signatures, gene expression signatures, antibiotic stewardship, antimicrobial resistance
MeSH terms
Anti-Bacterial Agents, Diagnosis, Differential, Humans, Meningitis, Viral, Biomarkers, Meningitis, Bacterial, Proteomics

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