Pathogen detection in acellular cerebrospinal fluid: diagnostic insights from a pediatric cohort in Colombia

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 <i>E. coli</i> K1 and <i>Streptococcus agalactiae</i>. 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.