Leveraging BioFire FilmArray (Multiplex Polymerase Chain Reaction) to Unmask Varicella Zoster Virus Meningoencephalitis: A Rare Case Report of Geriatric Neuro-Infection from North India

¹Junior Resident, Department of Medical Microbiology, AIIMS Rishikesh, India

²Professor, Department of Medical Microbiology, AIIMS Rishikesh, India

³Additional Professor, Department of Internal Medicine, AIIMS Rishikesh, India

⁴Senior Resident, Department of Medical Microbiology, AIIMS Rishikesh, India

⁵Junior Resident, Department of Diagnostic and Interventional Radiology, AIIMS Rishikesh, India

*Corresponding author: Arushi Gupta, Junior Resident, Department of Medical Microbiology, AIIMS Rishikesh, India, Tel: 9779268784, Email: [email protected]

Received Date: June 09, 2024

Published Date: July 31, 2024

Citation: Gupta A, et al. (2024). Leveraging BioFire FilmArray (Multiplex Polymerase Chain Reaction) to Unmask Varicella Zoster Virus Meningoencephalitis: A Rare Case Report of Geriatric Neuro-Infection from North India. Mathews J Case Rep. 9(7):177.

Copyrights: Gupta A, et al. (2024).

ABSTRACT

Meningoencephalitis typically presents with fever and signs of meningeal irritation thereby, making it difficult to distinguish bacterial, viral and fungal aetiology merely on clinical examination. Therefore, the use of multiplex PCR (Polymerase Chain Reaction) targeting multiple etiological agents enhances accurate diagnosis and shortens turn-around time. We hereby report a case of acute VZV (Varicella zoster virus) encephalitis with superadded bacterial infections in an elderly male patient diagnosed via Biofire FilmArray, in Uttarakhand region of North India.

A 69-year-old male patient presented to Emergency department of AIIMS, Rishikesh with complaints of fever, headache, projectile vomiting and altered mental sensorium from where he was admitted in General Medicine HDU (high dependency unit) with a working diagnosis of acute meningoencephalitis. Film Array meningoencephalitis (ME) panel (BioFire Diagnostics, LLC, Salt Lake City, Utah) [1] combining 14 pathogens into a single cartridge-based nested multiplex PCR was performed as a point-of-care test. Various lab investigations including CSF counts, aerobic cultures, microscopy, CSF CBNAAT, MRI, NCCT Head, EEG were also done to rule out other potential causes.

Microscopic staining analysis and cerebrospinal fluid culture were both negative. However, CSF Biofire came positive for VZV guiding precise treatment. VP (Ventriculo Peritoneal) shunt was placed in view of obstructive hydrocephalus revealed on NCCT-head. Repeated interventions like intubation, co-morbidities and geriatric age group lead to development of VAP (Ventilator Associated Pneumonia) due to super added bacterial infection for which culture guided antimicrobial therapy was given. Full course of appropriate antiviral treatment was given, and patient was discharged in a haemodynamically stable condition.

Keywords: Geriatric Patient, Molecular Diagnosis, Neuro-infections, POCT (Point of Care Test), Syndromic Diagnosis, Viral Infections.