Multiplex Real Time PCR Versus Classical CSF Analysis Study Conducted on a Moroccan Pediatric Population

Abstract

The aim of this study is to evaluate the contribution of neuromeningeal multiplex PCR in the diagnosis of infectious meningitis within a pediatric hospital population. The secondary objective is to compare the diagnostic performance of this technique compared with conventional methods in order to optimize the utilization of multiplex PCR. This work is a retrospective study of 112 children (1 month–17 years) investigated for suspected meningitis between 2020 and 2025. CSF samples were analyzed using conventional methods and the multiplex PCR panel, with demographic and biological data reviewed. The study included 67 boys (60%) and 45 girls (40%) (male-to-female ratio 1.49), with a mean age of 6.67 years; children aged 3–5 years were the most represented. Laboratory activity increased over time, reaching 37 multiplex PCR analyses in 2024–2025. Multiplex PCR was positive in 18 patients (16%). Viruses accounted for 85% of pathogens, mainly Enteroviruses (65%), followed by HHV-6 (29%) and HSV-2 (6%). Three bacterial cases and two co-infections (11.1%) were identified. Most patients had normal CSF cytology (71%); among PCR-positive cases, 33% showed elevated CSF protein, with normal glucose in all samples. CRP levels were elevated to very high in 55.6% of cases. In conclusion; the integration of multiplex PCR as a first-line test in symptomatic children, regardless of CSF parameters, appears justified. It allows for the optimization of the care pathway through a reduction in hospitalization duration and unnecessary treatments.