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

Meningitis and meningoencephalitis are life-threatening neurological emergencies associated with substantial morbidity and mortality. Rapid etiological diagnosis is essential for their optimal management. This study aimed to describe the epidemiological profile and spectrum of microorganisms detected in patients with suspected central nervous system infections analyzed using syndromic multiplex PCR panel at a Moroccan tertiary hospital. We conducted a retrospective descriptive study including all cerebrospinal fluid (CSF) samples analyzed with the BIOFIRE ® FilmArray ® Meningitis/Encephalitis Panel at the Central Virology Laboratory of Ibn Sina University Hospital, Rabat, Morocco, between January 2021 and May 2025. Demographic, microbiological, cytological, and biochemical data were collected and analyzed using Jamovi (version 2.6.26). A total of 2,645 patients with suspected meningitis or meningoencephalitis were included. The BIOFIRE ® FilmArray ® ME Panel was positive in 274 patients (10.4%). A total of 288 microorganisms were detected, including 125 bacteria (43.4%), 143 viruses (49.6%), and 20 Cryptococcus neoformans/gattii (7.0%). Streptococcus pneumoniae was the most frequently detected bacterial microorganism (66.4%, N = 83), whereas Enterovirus and Human Herpesvirus 6 were the leading viral agents (25.2%, N = 36 and 23.8%, N = 34, respectively), while Herpes simplex virus 1 was observed in 25 detections (17.5%). Viral detections were significantly more frequent in children (65.7% vs. 34.3% in adults, p < 0.001), while Streptococcus pneumoniae was more frequently detected in intensive care/emergency departments (61.4% vs. 38.6% in other care settings, p = 0.006). CSF findings associated with bacterial detections showed the typical pattern of neutrophilic pleocytosis, hypoglycorrhachia, and hyperproteinorachia, whereas viral detections displayed more heterogeneous profiles. Notably, 70 of 143 viral detections (49.0%) occurred in CSF samples with fewer than 10 white blood cells/mm³. This study provides a valuable insight at national and regional level to the existing literature. The predominance of Streptococcus pneumoniae among adults and viral detections among children in addition to the frequent detection of viral microorganisms in minimally inflammatory CSF highlights the potential complementary role of multiplex PCR in the diagnostic work-up of suspected meningitis and meningoencephalitis.