Acute West Nile Virus Meningoencephalitis Diagnosed Via Metagenomic Deep Sequencing of Cerebrospinal Fluid in a Renal Transplant Patient.
Acute West Nile Virus Meningoencephalitis Diagnosed Via Metagenomic Deep Sequencing of Cerebrospinal Fluid in a Renal Transplant Patient.
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DOI：
10.1111/ajt.14058
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发表时间：
2017-03
期刊：
影响因子：
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通讯作者：
DeRisi JL
中科院分区：
文献类型：
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作者：
Wilson MR;Zimmermann LL;Crawford ED;Sample HA;Soni PR;Baker AN;Khan LM;DeRisi JL
实体器官移植患者很容易因各种病毒感染而遭受神经系统并发症，并且可以成为人群中的哨兵，他们首先从新兴感染中获得严重并发症，如最近几波虫媒病毒，包括西尼罗河病毒，基孔肯雅病毒，寨卡病毒和登革热病毒。病毒性脑炎可能原因的多样性和快速变化的格局对传统的基于候选的传染病诊断提出了巨大挑战，这些诊断已经无法在大约50%的脑炎病例中识别致病病原体。我们报告一例因肾移植而接受免疫抑制治疗的14岁女孩，出现急性脑膜脑炎。传统的诊断未能确定病因。从她的脑脊液中提取的RNA进行了无偏的宏基因组深度测序，并使用基于Cas9的宿主耗竭技术进行了增强。该分析确定了西尼罗河病毒（WNV）。恢复期血清学随后证实了西尼罗河病毒血清转化。这些结果支持宏基因组深度测序在疑似病毒性脑炎的背景下具有明确的临床作用，特别是在高风险移植患者人群的背景下。无偏宏基因组深度测序鉴定了一名接受肾移植并患有急性脑膜脑炎的儿童脑脊液中的西尼罗河病毒。
Solid organ transplant patients are vulnerable to suffering neurologic complications from a wide array of viral infections and can be sentinels in the population who are first to get serious complications from emerging infections like the recent waves of arboviruses, including West Nile virus, Chikungunya virus, Zika virus, and Dengue virus. The diverse and rapidly changing landscape of possible causes of viral encephalitis poses great challenges for traditional candidate‐based infectious disease diagnostics that already fail to identify a causative pathogen in approximately 50% of encephalitis cases. We present the case of a 14‐year‐old girl on immunosuppression for a renal transplant who presented with acute meningoencephalitis. Traditional diagnostics failed to identify an etiology. RNA extracted from her cerebrospinal fluid was subjected to unbiased metagenomic deep sequencing, enhanced with the use of a Cas9‐based technique for host depletion. This analysis identified West Nile virus (WNV). Convalescent serum serologies subsequently confirmed WNV seroconversion. These results support a clear clinical role for metagenomic deep sequencing in the setting of suspected viral encephalitis, especially in the context of the high‐risk transplant patient population. Unbiased metagenomic deep sequencing identifies West Nile virus in the cerebrospinal fluid of a child who had a renal transplant and presented with acute meningoencephalitis.