Central nervous system infections

Molecular testing methods are available to conduct diagnostic tests for pathogen identification

By Dr Aparna Kotekar

To treat something you need to detect it first, and often it is the timely diagnosis which plays a crucial role in a patient being saved. Broadly, most diseases can be classified as infectious or non-infectious. With a large variety of pathogens, identifying infections is a major challenge.
Various kinds of infections pose different degree of challenges for diagnosis and treatment. However, infections of the central nervous system (CNS) are life-threatening, especially in children. The clinical manifestation of CNS infections in children is different from adults.
Central nervous system is an organ system consisting of the brain and the spinal cord and it controls most parts of the body and mind. Any infection or damage to any part of the CNS can easily become life-threatening. Therefore these conditions need quick diagnosis and treatment.

Advances in diagnostic sciences have made detecting central nervous system infections faster and more accurate.

Common CNS infections
Meningitis, encephalitis, myelitis and abscess are some of the most common and dangerous CNS infections. They commonly spread through blood but they can also spread through other ways such as inflammation of the ear (otitis), inflammation of the sinus (sinusitis), or build-up of pus in teeth and gum (dental abscess). The infections can also spread inside the body through neural pathways and can be contracted by immunity compromised patients.
Usually, the blood-brain barrier provides strong protection against the infections by preventing the entry of pathogens. However, once this barrier is breached, the infections become increasingly difficult to treat with passage of time which increases chances of morbidity and mortality.
Age, immunity status, epidemiological trends and systemic infections are some of the factors which affect the kind of pathogens invading the CNS. Infants and children are largely considered to be the age group which contracts these infections most easily. The symptoms presented by CNS infections include severe headache, back pain, stiff neck, weakness, seizures and even paralysis.

Aparna Kotekar is HOD- Molecular Department with iGenetic Diagnostics.

Difficulty in detecting CNS infections
One of the major reasons why CNS infections are difficult to detect is that these infections can be caused by a variety of pathogens including, bacteria, virus, fungi, protozoa and even parasites. Identifying the causative pathogens is not easy, and such patients are often treated with broad spectrum antimicrobials. Exposure to such a variety of antibiotics results in increased antimicrobial resistance, failure of treatment, serious side-effects and increased treatment costs.

While pathogen detection by culturing the causative organisms is considered to be the gold standard for infection diagnosis, the process can easily take 72 hours for bacteria and even more for fungi. Routine labs cannot necessarily culture viruses which are known to be affecting a major number of cases. Also, microbiological methods show false negatives in patients who were previously treated with antimicrobials.

The solutions
Advances in diagnostic sciences have made detecting central nervous system infections faster and more accurate than the traditional methods. Molecular testing methods are today available to conduct diagnostic tests for pathogen identification.
In a study recently published in the International Journal of Science and Research in December 2018, it was shown that 70% of CNS infections in paediatric cases are caused by bacteria and viruses. The important finding is that the CNS panel employed using molecular testing accurately identified the pathogens in 24 hours enabling timely treatment of these patients.
What is required is to increase advanced diagnostic technological penetration with Government and non-Government healthcare programmes across the country and bring these services within reach of the common man and the under-served sections of the society. Because unless the people of the country are able to access life-saving diagnostics, providing quality treatment will always be a challenge for doctors and hospitals.


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