Retrospective evaluation of the factors with real-time PCR method in patients who applied to the emergency department and had lumbar puncture with prediagnosis of central nervous system infection

Aim: In this study, it was aimed to determine the viral and bacterial agents by PCR method and to evaluate the PCR results together with other laboratory results and clinics of the cases who applied to the emergency department with the preliminary diagnosis of CNS infection. Methods: The study was conducted by retrospectively examining the files of 45 patients who were over the age of 18, non-pregnant, had full data in the file, had CSF PCR for diagnostic purposes and applied to the Emergency Service of Manisa Celal Bayar Medical Faculty Hospital between 01.01.2018 and 01.12.2020 with the suspicion of CNS infection. In addition to the PCR results, the patient's history, complaints, laboratory findings, clinic and clinical results were obtained. Results: Of the cases, 55.6% were male and the median age was 56. The most common symptoms of patients were confusion, fever and headache. The median of CSF glucose value of the cases was 69, and the median of CSF protein was 81. In 11.1% of the cases, growth was detected in CSF culture, 20% in CSF PCR, and 24.4% had cranial CT findings. Treatment was applied to 86.7% of the cases, and 26.7% of them died. In PCR positive cases, the presence of leukocytes in CSF, CSF protein level and PMN/lymphocyte levels were significantly higher, while CSF glucose level and lymphocyte percentage were found to be low. Nine cases were diagnosed by PCR. Six of them were bacterial agents, two were HSV, and one was HHV-6. There was no significant difference between mortality, complications, hospitalization in the intensive care unit and receiving treatment. Conclusion: The causative agent was determined by PCR in nine and culture in five of those admitted to the emergency department with the suspicion of CNS infection. In our study, it was found that PCR was superior in diagnosing than culture. The most common bacterial agent was S. pneumoniae and the