Clinical Scorecard: The 60 Percent Diagnostic Gap in M/E

At a Glance

Key Highlights

• Over 60% of M/E cases remain undiagnosed after comprehensive evaluation.
• Traditional diagnostics are hypothesis-driven and limited in scope.
• Early use of comprehensive metagenomic next-generation sequencing (mNGS) can reduce diagnostic time and additional testing.
• mNGS testing can decrease microbiologic tests ordered by over 60% in infectious cases.
• Collaboration among laboratory, neurology, and infectious disease teams is crucial for mNGS result interpretation.

Guideline-Based Recommendations

Diagnosis

• Consider mNGS for patients with severe or atypical neurologic presentations.
• Use mNGS when culture-negative CSF persists with concern for infection.

Management

• Integrate mNGS into the diagnostic pathway to inform treatment decisions.
• Narrow empiric therapy based on identified pathogens from mNGS results.

Monitoring & Follow-up

• Evaluate mNGS results in clinical context to guide ongoing management.

Risks

• Contamination control is essential due to the high sensitivity of mNGS.

Patient & Prescribing Data

Patients with suspected infectious or autoimmune causes of meningitis/encephalitis.

Earlier mNGS testing may influence hospital length of stay and timing of immunotherapy.

Clinical Best Practices

• Maintain strict pre-analytic handling and appropriate negative controls for mNGS.
• Ensure standardized reporting and clinician education for accurate result interpretation.
• Develop clear ordering criteria for mNGS within diagnostic workflows.

References

• Open Forum Infectious Diseases Study