{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:11:58Z","timestamp":1785413518227,"version":"3.56.0"},"reference-count":33,"publisher":"American Society for Microbiology","issue":"1","license":[{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      The diagnosis of pediatric meningoencephalitis has traditionally relied on the detection of inflammatory markers in cerebrospinal fluid (CSF), particularly pleocytosis, as an indirect indicator of infection. This assumption presumes that microbial invasion of the central nervous system consistently triggers a measurable immune response. In this prospective observational study conducted in Cartagena, Colombia, we enrolled 166 pediatric patients with suspected meningoencephalitis. All patients underwent testing with the FilmArray Meningitis\/Encephalitis (FA-M\/E) panel for direct pathogen detection in CSF, and results were compared to conventional CSF cytochemical analysis and culture. The FA-M\/E panel identified a pathogen in 21 of 166 patients (12.6%), whereas CSF cultures were negative in all cases. Detected pathogens included 16 viruses (76.2%), most frequently Enterovirus and Human Herpesvirus 6 and five bacteria (23.8%), including\n                      <jats:italic toggle=\"yes\">Escherichia coli<\/jats:italic>\n                      K1 and\n                      <jats:italic toggle=\"yes\">Streptococcus agalactiae<\/jats:italic>\n                      . Remarkably, 100% (21\/21) of the FA-M\/E-positive samples exhibited complete absence of pleocytosis (0 white blood cells\/\u00b5L). Additionally, 33.3% (7\/21) showed entirely normal CSF biochemistry. Among these cases with a normal CSF profile, the panel identified two clinically significant bacterial infections and five viral infections that would have otherwise gone undetected. These findings demonstrate that traditional CSF parameters are poor predictors of infection in patients with a positive molecular result. Routine reliance on cytochemical analysis alone may therefore delay diagnosis and treatment. Our results support the use of molecular diagnostics as a frontline tool, even in the absence of classical inflammatory CSF markers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>IMPORTANCE<\/jats:title>\n                    <jats:p>\n                      This study challenges the long-standing paradigm that abnormal cerebrospinal fluid (CSF) findings are required to justify molecular testing in pediatric meningoencephalitis. We show that critical central nervous system (CNS) infections can present with entirely normal CSF profiles, including cases caused by high-risk pathogens such as\n                      <jats:italic toggle=\"yes\">E. coli<\/jats:italic>\n                      K1 and\n                      <jats:italic toggle=\"yes\">Streptococcus agalactiae<\/jats:italic>\n                      . By highlighting the limitations of pleocytosis and biochemical markers in detecting early CNS infection, our data underscore the importance of incorporating molecular diagnostics into routine clinical evaluation, particularly for high-risk pediatric populations. Failure to do so may result in missed or delayed diagnoses and suboptimal treatment.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.02122-25","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T13:00:48Z","timestamp":1763989248000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["Pathogen detection in acellular cerebrospinal fluid: diagnostic insights from a pediatric cohort in Colombia"],"prefix":"10.1128","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5764-6326","authenticated-orcid":false,"given":"Jhonny Jes\u00fas","family":"Pati\u00f1o Pati\u00f1o","sequence":"first","affiliation":[{"name":"Grupo Caribe de Investigaci\u00f3n en Enfermedades de Tipo Infeccioso y Resistencia Microbiana, Universidad Metropolitana","place":["Barranquilla, Colombia"]},{"id":[{"id":"https:\/\/ror.org\/0409zd934","id-type":"ROR","asserted-by":"publisher"}],"name":"Departamento de Medicina Interna, Universidad de Cartagena","place":["Cartagena, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9404-5370","authenticated-orcid":false,"given":"Elber","family":"Osorio-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Grupo Caribe de Investigaci\u00f3n en Enfermedades de Tipo Infeccioso y Resistencia Microbiana, Universidad Metropolitana","place":["Barranquilla, Colombia"]},{"name":"Department of intensive Medicine, Group Care Medicine, Cl\u00ednica Iberoam\u00e9rica.","place":["Barranquilla, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7739-3451","authenticated-orcid":false,"given":"Yina Paola","family":"Garc\u00eda Toscano","sequence":"additional","affiliation":[{"name":"Grupo Caribe de Investigaci\u00f3n en Enfermedades de Tipo Infeccioso y Resistencia Microbiana, Universidad Metropolitana","place":["Barranquilla, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margarita","family":"Filott Tamara","sequence":"additional","affiliation":[{"name":"Grupo Caribe de Investigaci\u00f3n en Enfermedades de Tipo Infeccioso y Resistencia Microbiana, Universidad Metropolitana","place":["Barranquilla, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7637-5106","authenticated-orcid":false,"given":"Marcio","family":"De-\u00c1vila-Arias","sequence":"additional","affiliation":[{"name":"Grupo de investigaci\u00f3n en Biomedicina, Facultad de Ciencias b\u00e1sicas biom\u00e9dicas, Universidad Metropolitana","place":["Barranquilla, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6424-7254","authenticated-orcid":false,"given":"Alexander","family":"Rodr\u00edguez Sanju\u00e1n","sequence":"additional","affiliation":[{"name":"Grupo de Investigaci\u00f3n en Medicina Traslacional, Departamento de Medicina, Universidad Metropolitana","place":["Barranquilla, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Luis","family":"Villarreal-Camacho","sequence":"additional","affiliation":[{"name":"Grupo de Investigaci\u00f3n en Medicina Traslacional, Departamento de Medicina, Universidad Metropolitana","place":["Barranquilla, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4106-9357","authenticated-orcid":false,"given":"Walter","family":"Mart\u00ednez De la Rosa","sequence":"additional","affiliation":[{"name":"Grupo de investigaci\u00f3n en Biomedicina, Facultad de Ciencias b\u00e1sicas biom\u00e9dicas, Universidad Metropolitana","place":["Barranquilla, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Bilbao Ram\u00edrez","sequence":"additional","affiliation":[{"name":"Grupo SANUS VIVENTIUM, Departamento de Investigaciones, Universidad Metropolitana","place":["Barranquilla, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilfrido","family":"Coronell-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Departamento de Pediatr\u00eda e Infectolog\u00eda, Universidad de Cartagena","place":["Cartagena, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8335-9929","authenticated-orcid":true,"given":"Alfonso","family":"Bettin Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Grupo Caribe de Investigaci\u00f3n en Enfermedades de Tipo Infeccioso y Resistencia Microbiana, Universidad Metropolitana","place":["Barranquilla, Colombia"]},{"name":"Grupo de Investigaci\u00f3n en Medicina Traslacional, Departamento de Medicina, Universidad Metropolitana","place":["Barranquilla, 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