Multiplex PCR positive in 10.4% of 2,645 suspected meningitis cases at Moroccan hospital

A retrospective descriptive study reported that a syndromic multiplex PCR panel was positive in 274 of 2,645 patients with suspected meningitis or meningoencephalitis at Ibn Sina University Hospital in Rabat, Morocco, a rate of 10.4%. The analysis identified 288 microorganisms across the positive results, including 143 viruses, 125 bacteria and 20 detections of Cryptococcus neoformans/gattii. These findings describe the organisms detected in the selected clinical population rather than the full etiological spectrum across Morocco.

Researchers retrospectively reviewed cerebrospinal fluid samples sent to the hospital’s Central Virology Laboratory between January 2021 and May 2025. The samples were analyzed with the BIOFIRE FilmArray Meningitis/Encephalitis Panel. The study population comprised 2,645 patients with suspected central nervous system infections, and the investigators collected demographic, microbiological, cytological and biochemical data for analysis in Jamovi version 2.6.26. The study therefore provides a single-center clinical snapshot of syndromic panel findings over the specified period.

Viruses accounted for 49.6% of the 288 microorganism detections, bacteria for 43.4% and C. neoformans/gattii for 7.0%. Streptococcus pneumoniae was the most frequently detected bacterial microorganism, with 83 detections representing 66.4% of bacterial detections. Enterovirus was the leading viral agent, with 36 detections, or 25.2% of viral detections, followed by human herpesvirus 6 with 34 detections, or 23.8%. Herpes simplex virus 1 accounted for 25 viral detections, equivalent to 17.5% of the viral total.

The reported patterns differed by age and care setting. Viral detections were significantly more frequent in children than in adults, with reported proportions of 65.7% and 34.3%, respectively (p<0.001). S. pneumoniae detections were more frequent in intensive-care and emergency departments than in other care settings, at 61.4% and 38.6%, respectively (p=0.006). Cerebrospinal fluid associated with bacterial detections showed a typical pattern of neutrophilic pleocytosis, hypoglycorrhachia and hyperproteinorachia, while findings accompanying viral detections were more heterogeneous. Notably, 70 of the 143 viral detections, or 49.0%, occurred in samples with fewer than 10 white blood cells/mm³.

The authors interpreted the results as evidence that multiplex PCR may have a complementary role in the diagnostic work-up of suspected meningitis and meningoencephalitis, particularly because viral organisms were frequently detected in samples with limited inflammation. The results do not demonstrate improved clinical outcomes, treatment effects or population-wide disease burden. As a retrospective, single-hospital study based on syndromic panel testing, it is also limited in generalizability beyond the sampled patients and does not by itself establish each patient’s final clinical diagnosis or capture pathogens outside the panel’s detected spectrum.

Subject of Research: Epidemiological and etiological patterns detected by syndromic multiplex PCR in suspected meningitis and meningoencephalitis

Article Title: Syndromic multiplex PCR in meningitis and meningoencephalitis: epidemiological patterns and etiological spectrum in 2645 moroccan suspected cases

Article References: Touyar, N., Hafidi, N. E., Slaoui, M., Benchekroun, S., Mahraoui, C., Agarrab, N., Aminou, S., El-Amin, G., Zouaki, A., Siyar, H., Belhaj, N., Farissi, A., Belefquih, B., Harrak, S. E., Ed-Dafali, L., Hilali, S. E., Bnouhanna, W., Oukheda, N., Belkhettab, S., … Kabbaj, H. (2026). Syndromic multiplex PCR in meningitis and meningoencephalitis: epidemiological patterns and etiological spectrum in 2645 moroccan suspected cases. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14502-0

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14502-0

Keywords: meningitis, meningoencephalitis, multiplex PCR, cerebrospinal fluid, Morocco, pathogen detection, viral infections, bacterial meningitis, Syndromic, multiplex, epidemiological, patterns