Clinical features of aseptic meningitis with varicella zoster virus infection diagnosed by next-generation sequencing: case reports

Pneumocystis jirovecii, Cytomegalovirus and varicella-zoster virus are all opportunistically infective pathogens, but pulmonary co-infection with these pathogens is rare. Herein, this case report describes a patient with autoimmune haemolytic anaemia treated with methylprednisolone and cyclosporine that presented with rapidly progressive severe respiratory failure. Analysis of microbial nucleic acid sequences in both blood and sputum using next-generation sequencing revealed pulmonary co-infection with Pneumocystis jirovecii, varicella-zoster virus, and possibly Cytomegalovirus. After timely targeted and supportive treatments, the patient recovered. This case report highlights the imaging features of co-infection with these pathogens, the importance of next-generation sequencing for early diagnosis in immunosuppressed patients, and the effects of corticosteroid therapy.

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Aseptic meningitis caused by torque teno virus in an infant: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-019-2233-2 ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 3

Author(s):

Yoji Ikuta ◽

Kunihiro Oba ◽

Emina Nai ◽

Tatsuo Katori ◽

Masanori Hashino ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Next Generation Sequencing ◽

Virus Infection ◽

Aseptic Meningitis ◽

Immunoglobulin M ◽

Torque Teno Virus ◽

High Dose ◽

Next Generation ◽

Developmental Problems ◽

Generation Sequencing

Abstract Background Torque teno virus-induced aseptic meningitis has not been documented, although torque teno virus infections still remain under consideration for etiological agents. This study identified a torque teno virus sequence using next generation sequencing and immunoglobulin M response to the torque teno virus antigen, therefore, that would be a comprehensive diagnosis for torque teno virus infection. Case presentation A 2-month-old Japanese boy was brought to our hospital because he was irritable, drowsy, and lethargic. He was admitted based on his test results which indicated the possibility of septic meningitis. He was started on treatment with high-dose antibiotics and steroids. On the third day of hospitalization, he became afebrile with improvement in his general status and was discharged on the sixth day. He had no developmental problems for up to 1 year after discharge. Metagenomic ribonucleic acid-Seq pathogen detection using next generation sequencing of a sample of his cerebrospinal fluid, which was collected at admission, revealed three short reads homologous to those in torque teno virus out of a total of 1,708,516 reads. This finding indicated that our patient was positive compared to the torque teno virus-negative cerebrospinal fluid samples (controls) from 13 other patients. The torque teno virus has been shown to have a whole genome sequence of 2810 nt by polymerase chain reaction. We prepared a recombinant GP2 antigen from torque teno virus and used it to study our patient’s anti-torque teno virus immune response. An anti-GP2 serum immunoglobulin M response was detected, providing further supportive evidence of torque teno virus infection. Conclusions This case speculates that torque teno virus-induced aseptic meningitis has a good course. New technologies like next generation sequencing can help in the identification of such cases, and an accumulation of future cases is expected.

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A case of paraplegia due to asymptomatic varicella-zoster virus infection in AIDS patient unexpectedly diagnosed by CSF metagenomic next-generation sequencing

BMC Infectious Diseases ◽

10.1186/s12879-021-06611-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhiman Xie ◽

Jingzhen Lai ◽

Chuanyi Ning ◽

Guangjing Ruan ◽

Hao Liang

Keyword(s):

Spinal Cord ◽

Next Generation Sequencing ◽

Varicella Zoster Virus ◽

Disease Diagnosis ◽

Next Generation ◽

Thoracic Spinal Cord ◽

Varicella Zoster ◽

Thoracic Spinal ◽

Generation Sequencing ◽

Hiv Aids

Abstract Background Varicella-zoster virus (VZV) infection may induce central nervous system complications in HIV/AIDS patients. However, it is rare to have paraplegia caused by VZV infection but no herpes zoster clinically. Asymptomatic VZV infection in HIV/AIDS patient increased the difficulty of diagnosis. Case presentation We reported a 41-year-old male AIDS patient with rare asymptomatic VZV infection-induced paraplegia after his anti-retroviral therapy initiation. MRI of the spinal cord showed the morphology of the thoracic spinal cord was irregular and locally inflated. The patient was confirmed as VZV induced thoracic myelomyelitis by using the cerebrospinal fluid for metagenomic next-generation sequencing (mNGS). Conclusions mNGS may contribute to disease diagnosis for asymptomatic VZV infection-induced myelitis.

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