Meningitis is an inflammatory condition involving the membranes covering the central nervous system (CNS) that can be caused by bacteria, viruses, parasites and fungi11. Mount HR, Boyle SD. Aseptic and bacterial meningitis: evaluation, treatment, and prevention. Am Fam Physician. 2017;96:314-22.. According to the Global Burden of Diseases study, in 2016 there number of incident cases were estimated at 2.82 million while the number of meningitis deaths were estimated at 318,400 cases. Most deaths occurred in countries of low sociodemographic index as the ones in sub-Saharan Africa, in which the incident cases are the highest, 207.4 per 100,000 inhabitants22. Zunt JR, Kassebaum NJ, Blake N, Glennie L, Wright C, Nichols E, et al. Global, regional, and national burden of meningitis, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018;17:1061-82.. In the United States, every year approximately 4,100 cases of bacterial meningitis are diagnosed leading to 500 deaths. On the other hand, viral etiology is more common in patients under 15 years old, with 20,000 cases and an average of 1,400 deaths per year11. Mount HR, Boyle SD. Aseptic and bacterial meningitis: evaluation, treatment, and prevention. Am Fam Physician. 2017;96:314-22.,33. Vora NM, Holman RC, Mehal JM, Steiner CA, Blanton J, Sejvar J. Burden of encephalitis-associated hospitalizations in the United States, 1998-2010. Neurology. 2014;82:443-51..
From the Public Health point of view, rapid diagnosis and treatment of CNS infections are crucial to impact the morbidity and mortality. In addition, in many areas around the world, particularly in rural areas, the capacity to perform traditional diagnostic assays, such as culture or the detection of bacterial antigens is limited or non-existent, leading to delayed or absence of the etiological diagnosis22. Zunt JR, Kassebaum NJ, Blake N, Glennie L, Wright C, Nichols E, et al. Global, regional, and national burden of meningitis, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018;17:1061-82.. Traditionally, laboratory diagnosis of meningitis have included examination of cerebrospinal fluid (CSF) specimens for cells count, measurement of glucose and protein levels, and the gram staining; these tests may suggest the type of infection but they are not specific. Bacterial cultures from CSF can provide the diagnosis, however, it may take several days and it has critical limitations such as the sensitivity to detect some pathogens11. Mount HR, Boyle SD. Aseptic and bacterial meningitis: evaluation, treatment, and prevention. Am Fam Physician. 2017;96:314-22.. Regarding viral detection, before the development of molecular methods such as Polymerase Chain Reaction (PCR), the isolation of pathogens traditionally relied on cell culture, despite the long period required to release the result, aside from the need of technical expertise66. Dubos F, Korczowski B, Aygun DA, Martinot A, Prat C, Galetto-Lacour A, et al. Distinguishing between bacterial and aseptic meningitis in children: European comparison of two clinical decision rules. Arch Dis Child. 2010;95:963-7..
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