Case Report: A Candida Meningitis in an Immunocompetent Patient Detected Through the Next-Generation Sequencing

Background: Fungal infections of the central nervous system (CNS) are not commonly seen clinically. Clinical diagnosis of fungal infections often depend on the pathogen culture and the clinical features. This method is time-consuming and insensitive, which can lead to misdiagnosis. The authors introduce an adult patient with fungal infections diagnosed by next-generation sequencing (NGS).Case: The patient was a 60-year-old male Chinese who had both hypermyotonia of the lower extremities and fever. The auxiliary examinations such as MRI, CT, and cerebrospinal fluid (CSF) analysis showed obvious abnormalities. Because of the difficulties in diagnosis, it was hard to determine the treatment plan. The NGS detected specific sequences of Candida albicans in 3 days. The patient was then treated with liposomal amphotericin B and fluconazole. About 3 weeks later, the symptoms of the patient improved significantly and he was discharged from the hospital.Conclusion: Compared with the routine cultural method, NGS has made a huge advancement in infection diagnosis and targeting antimicrobial therapy for CNS infection.

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Detection of Listeria monocytogenes in a patient with meningoencephalitis using next-generation sequencing: a case report

BMC Infectious Diseases ◽

10.1186/s12879-020-05447-z ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Zi-Wei Lan ◽

Min-Jia Xiao ◽

Yuan-lin Guan ◽

Ya-Jing Zhan ◽

Xiang-Qi Tang

Keyword(s):

Listeria Monocytogenes ◽

Next Generation Sequencing ◽

Mammalian Cells ◽

Clinical Manifestations ◽

Bacterial Pathogen ◽

Next Generation ◽

Accurate Treatment ◽

The Central Nervous System ◽

Next Generation Sequencing Ngs ◽

Generation Sequencing

Abstract Background Listeria monocytogenes (L. monocytogenes) is a facultative intracellular bacterial pathogen which can invade different mammalian cells and reach to the central nervous system (CNS), leading to meningoencephalitis and brain abscesses. In the diagnosis of L. monocytogenes meningoencephalitis (LMM), the traditional test often reports negative owing to the antibiotic treatment or a low number of bacteria in the cerebrospinal fluid. To date, timely diagnosis and accurate treatment remains a challenge for patients with listeria infections. Case presentation We present the case of a 66-year-old woman whose clinical manifestations were suspected as tuberculous meningoencephalitis, but the case was finally properly diagnosed as LMM by next-generation sequencing (NGS). The patient was successfully treated using a combined antibacterial therapy, comprising ampicillin and trimethoprim-sulfamethoxazole. Conclusion To improve the sensitivity of LMM diagnosis, we used NGS for the detection of L. monocytogenes. Hence, the clinical utility of this approach can be very helpful since it provides quickly and trust results.

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Rapid Genomic Diagnosis of Fungal Infections in the Age of Next-Generation Sequencing

Journal of Fungi ◽

10.3390/jof7080636 ◽

2021 ◽

Vol 7 (8) ◽

pp. 636

Author(s):

Chi-Ching Tsang ◽

Jade L. L. Teng ◽

Susanna K. P. Lau ◽

Patrick C. Y. Woo

Keyword(s):

Risk Factor ◽

Next Generation Sequencing ◽

Fungal Infections ◽

Laboratory Diagnosis ◽

Clinical Applications ◽

Hiv Positive ◽

Next Generation ◽

The Cost ◽

Next Generation Sequencing Ngs ◽

Generation Sequencing

Next-generation sequencing (NGS) technologies have recently developed beyond the research realm and started to mature into clinical applications. Here, we review the current use of NGS for laboratory diagnosis of fungal infections. Since the first reported case in 2014, >300 cases of fungal infections diagnosed by NGS were described. Pneumocystis jirovecii is the predominant fungus reported, constituting ~25% of the fungi detected. In ~12.5% of the cases, more than one fungus was detected by NGS. For P. jirovecii infections diagnosed by NGS, all 91 patients suffered from pneumonia and only 1 was HIV-positive. This is very different from the general epidemiology of P. jirovecii infections, of which HIV infection is the most important risk factor. The epidemiology of Talaromyces marneffei infection diagnosed by NGS is also different from its general epidemiology, in that only 3/11 patients were HIV-positive. The major advantage of using NGS for laboratory diagnosis is that it can pick up all pathogens, particularly when initial microbiological investigations are unfruitful. When the cost of NGS is further reduced, expertise more widely available and other obstacles overcome, NGS would be a useful tool for laboratory diagnosis of fungal infections, particularly for difficult-to-grow fungi and cases with low fungal loads.

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Comparison of the next-generation sequencing (NGS) technology with culture methods in the diagnosis of bacterial and fungal infections

Journal of Thoracic Disease ◽

10.21037/jtd-20-930 ◽

2020 ◽

Vol 12 (9) ◽

pp. 4924-4929

Author(s):

Peixin Chen ◽

Wenwen Sun ◽

Yayi He

Keyword(s):

Next Generation Sequencing ◽

Fungal Infections ◽

Next Generation ◽

Culture Methods ◽

Next Generation Sequencing Ngs ◽

Generation Sequencing

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The metagenomic next-generation sequencing in diagnosing central nervous system angiostrongyliasis: a case report

BMC Infectious Diseases ◽

10.1186/s12879-020-05410-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Li Feng ◽

Aiwu Zhang ◽

Jiali Que ◽

Hongyan Zhou ◽

Haiyan Wang ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Next Generation Sequencing ◽

Clinical Manifestations ◽

Next Generation ◽

Opening Pressure ◽

Csf Analysis ◽

Elevated Protein ◽

The Central Nervous System ◽

Generation Sequencing

Abstract Backgrounds The incidence of angiostrongyliasis is increasing in recent decades due to the expanding endemic areas all over the world. Clinicians face tremendous challenge of diagnosing angiostrongyliasis because of the lack of awareness of the disease and less effective definitive laboratory tests. Case presentation A 27-year-old man initially manifested skin itching, emesis, myalgia and quadriparesis. With progressive weakness of four limbs and elevated protein in the cerebrospinal fluid (CSF), he was diagnosed as Guillain-Barré syndrome and treated with intravenous methylprednisolone and immunoglobulin. However, the patient deteriorated with hyperpyrexia, headache and then persistent coma. The routine tests for Angiostrongylus cantonensis (A. cantonensis) with both the CSF and the serum were all negative. In contrast, the metagenomic next-generation sequencing (mNGS) was applied with the serum sample and the CSF sample in the middle phase. The central nervous system (CNS) angiostrongyliasis was diagnosed by mNGS with the mid-phase CSF, but not the mid-phase serum. At the same time, the CSF analysis revealed eosinophils ratio up to 67%. The discovery of A. cantonensis was confirmed by PCR with CSF later. Unfortunately, the patient died of severe angiostrongyliasis. During his hospitalization, mNGS was carried out repeatedly after definitive diagnosis and targeted treatment. The DNA strictly map reads number of A. cantonensis detected by mNGS was positively correlated with the CSF opening pressure and clinical manifestations. Conclusions The case of A. cantonensis infection highlights the benefit of mNGS as a target-free identification in disclosing the rare CNS angiostrongyliasis in the unusual season, while solid evidence from routine clinical testing was absent. The appropriate sample of mNGS should be chosen according to the life cycle of A. cantonensis. Besides, given the fact that the DNA reads number of A. cantonensis fluctuated with CSF opening pressure and clinical manifestations, whether mNGS could be applied as a marker of effectiveness of treatment is worth further exploration.

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