髄膜炎・脳炎の急性期診療における脳脊髄液多項目PCRパネル（FilmArray® MEパネル）の有用性
髄膜炎・脳炎の急性期診療における微生物学的検査の重要性は高い．FilmArray®髄膜炎・脳炎パネル（MEパネル）は14種類の病原体（ウイルス・細菌・真菌）の脳脊髄液PCRを1時間弱で施行できる検査で，2022年9月に保険収載された．当院ではそれ以前から臨床現場で使用する機会を得たため，成人70例を対象に，同検査の有用性について検討した．何らかの微生物が陽性となったのは18例（26％），うち8例（11％）ではMEパネルの結果が急性期の治療方針変更に寄与していた．結果が陰性の症例でもアシクロビル等の経験的な治療を省けるなど利点があった．今後本邦でもMEパネルの普及が望まれる．...
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| Published in | 臨床神経学 Vol. 63; no. 8; pp. 528 - 531 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本神経学会
2023
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-918X 1882-0654 |
| DOI | 10.5692/clinicalneurol.cn-001840 |
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| Abstract | 髄膜炎・脳炎の急性期診療における微生物学的検査の重要性は高い．FilmArray®髄膜炎・脳炎パネル（MEパネル）は14種類の病原体（ウイルス・細菌・真菌）の脳脊髄液PCRを1時間弱で施行できる検査で，2022年9月に保険収載された．当院ではそれ以前から臨床現場で使用する機会を得たため，成人70例を対象に，同検査の有用性について検討した．何らかの微生物が陽性となったのは18例（26％），うち8例（11％）ではMEパネルの結果が急性期の治療方針変更に寄与していた．結果が陰性の症例でもアシクロビル等の経験的な治療を省けるなど利点があった．今後本邦でもMEパネルの普及が望まれる． |
|---|---|
| AbstractList | 髄膜炎・脳炎の急性期診療における微生物学的検査の重要性は高い．FilmArray®髄膜炎・脳炎パネル（MEパネル）は14種類の病原体（ウイルス・細菌・真菌）の脳脊髄液PCRを1時間弱で施行できる検査で，2022年9月に保険収載された．当院ではそれ以前から臨床現場で使用する機会を得たため，成人70例を対象に，同検査の有用性について検討した．何らかの微生物が陽性となったのは18例（26％），うち8例（11％）ではMEパネルの結果が急性期の治療方針変更に寄与していた．結果が陰性の症例でもアシクロビル等の経験的な治療を省けるなど利点があった．今後本邦でもMEパネルの普及が望まれる． |
| Author | 石井, 淳子 吉村, 元 幸原, 伸夫 川本, 未知 太田, 和馬 藤原, 悟 |
| Author_xml | – sequence: 1 fullname: 太田, 和馬 organization: 神戸市立医療センター中央市民病院脳神経内科 – sequence: 1 fullname: 幸原, 伸夫 organization: 神戸市立医療センター中央市民病院脳神経内科 – sequence: 1 fullname: 藤原, 悟 organization: 神戸市立医療センター中央市民病院脳神経内科 – sequence: 1 fullname: 石井, 淳子 organization: 神戸市立医療センター中央市民病院脳神経内科 – sequence: 1 fullname: 吉村, 元 organization: 神戸市立医療センター中央市民病院脳神経内科 – sequence: 1 fullname: 川本, 未知 organization: 神戸市立医療センター中央市民病院脳神経内科 |
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| References | 9) Tarai B, Das P. FilmArray® meningitis/encephalitis (ME) panel, a rapid molecular platform for diagnosis of CNS infections in a tertiary care hospital in North India: one-and-half-year review. Neurol Sci 2019;40:81-88. 7) Domingues RB, Santos MVD, Leite FBVM, et al. FilmArray Meningitis/Encephalitis (ME) panel in the diagnosis of bacterial meningitis. Braz J Infect Dis 2019;23:468-470. 4) Hara M, Ishihara M, Nakajima H. Use of the FilmArray® Meningitis/Encephalitis panel to detect pathogenic microorganisms in cerebrospinal fluid specimens: a single-center retrospective study. J Int Med Res 2022;50:3000605221129561. 5) Sawyer MH, Webb DE, Balow JE, et al. Acyclovir-induced renal failure. Clinical course and histology. Am J Med 1988;84:1067-1071. 8) Ena J, Afonso-Carrillo RG, Bou-Collado M, et al. Evaluation of FilmArray ME panel for the rapid diagnosis of meningitis-encephalitis in emergency departments. Intern Emerg Med 2021;16:1289-1295. 2) Trujillo-Gómez J, Tsokani S, Arango-Ferreira C, et al. Biofire FilmArray Meningitis/Encephalitis panel for the aetiological diagnosis of central nervous system infections: a systematic review and diagnostic test accuracy meta-analysis. EClinicalMedicine 2022;44:101275. 1) Leber AL, Everhart K, Balada-Llasat JM, et al. Multicenter evaluation of BioFire FilmArray meningitis/encephalitis panel for detection of bacteria, viruses, and yeast in Cerebrospinal fluid specimens. J Clin Microbiol 2016;54:2251-2261. 6) Feldman S, Rodman J, Gregory B. Excessive serum concentrations of acyclovir and neurotoxicity. J Infect Dis 1988;157:385-388. 3) Otake S, Nakagawa Y, Ryu H, et al. How do we reduce acyclovir overuse? Impact of FilmArray meningitis/encephalitis panel tests for pediatric patients. J Infect Chemother 2022;28:1261-1265. |
| References_xml | – reference: 5) Sawyer MH, Webb DE, Balow JE, et al. Acyclovir-induced renal failure. Clinical course and histology. Am J Med 1988;84:1067-1071. – reference: 1) Leber AL, Everhart K, Balada-Llasat JM, et al. Multicenter evaluation of BioFire FilmArray meningitis/encephalitis panel for detection of bacteria, viruses, and yeast in Cerebrospinal fluid specimens. J Clin Microbiol 2016;54:2251-2261. – reference: 4) Hara M, Ishihara M, Nakajima H. Use of the FilmArray® Meningitis/Encephalitis panel to detect pathogenic microorganisms in cerebrospinal fluid specimens: a single-center retrospective study. J Int Med Res 2022;50:3000605221129561. – reference: 8) Ena J, Afonso-Carrillo RG, Bou-Collado M, et al. Evaluation of FilmArray ME panel for the rapid diagnosis of meningitis-encephalitis in emergency departments. Intern Emerg Med 2021;16:1289-1295. – reference: 6) Feldman S, Rodman J, Gregory B. Excessive serum concentrations of acyclovir and neurotoxicity. J Infect Dis 1988;157:385-388. – reference: 7) Domingues RB, Santos MVD, Leite FBVM, et al. FilmArray Meningitis/Encephalitis (ME) panel in the diagnosis of bacterial meningitis. Braz J Infect Dis 2019;23:468-470. – reference: 9) Tarai B, Das P. FilmArray® meningitis/encephalitis (ME) panel, a rapid molecular platform for diagnosis of CNS infections in a tertiary care hospital in North India: one-and-half-year review. Neurol Sci 2019;40:81-88. – reference: 2) Trujillo-Gómez J, Tsokani S, Arango-Ferreira C, et al. Biofire FilmArray Meningitis/Encephalitis panel for the aetiological diagnosis of central nervous system infections: a systematic review and diagnostic test accuracy meta-analysis. EClinicalMedicine 2022;44:101275. – reference: 3) Otake S, Nakagawa Y, Ryu H, et al. How do we reduce acyclovir overuse? Impact of FilmArray meningitis/encephalitis panel tests for pediatric patients. J Infect Chemother 2022;28:1261-1265. |
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| Title | 髄膜炎・脳炎の急性期診療における脳脊髄液多項目PCRパネル（FilmArray® MEパネル）の有用性 |
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