Untargeted metagenomic sequencing identifies Toscana virus in patients with idiopathic meningitis, southern Spain, 2015 to 2019.
Untargeted metagenomic sequencing identifies Toscana virus in patients with idiopathic meningitis, southern Spain, 2015 to 2019.
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DOI：
10.2807/1560-7917.es.2023.28.45.2200913
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发表时间：
2023-11
期刊：
影响因子：
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中科院分区：
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各种病原体，包括细菌、真菌、寄生虫和病毒，可导致脑膜炎。在引起脑膜炎的病毒中，托斯卡纳病毒（TOSV）是一种静脉病毒，通过白蛉叮咬传播。如果肠道病毒和疱疹病毒阴性的无菌性（非细菌性）脑膜炎患者回忆起最近的昆虫叮咬，则可能怀疑TOSV感染。其他流行病学因素（季节、农村地区）也可考虑。广泛的可能的脑膜炎病因构成了相当大的诊断挑战。非靶向宏基因组下一代测序（mNGS）可以潜在地识别在常规诊断面板中未考虑或检测到的病原体。在这项回顾性、单中心观察性研究中，我们调查了mNGS在了解传统方法失败时脑膜炎病因方面的有用性。对2015-2019年在西班牙南部住院的无菌性脑膜炎患者的脑脊液（CSF）样本进行了mNGS检测，常规检测未发现病因。记录了患者的人口统计学特征，医生询问了他们最近被昆虫叮咬的情况。对获得的病毒基因组序列进行遗传学分析。在23例特发性病例中，8例（均为男性;中位年龄：39岁，范围：15-78岁）确定了TOSV。五个病例生活在城市环境中，三个发生在秋天，只有一个回忆起昆虫叮咬。TOSV片段序列的系统发育分析支持一个基因型内重配事件。我们的研究强调了mNGS直接在CSF中识别病毒病原体的有用性。在西班牙南部，应考虑TOSV，无论是否召回昆虫叮咬或其他流行病学标准。与疾病相关的抗病毒TOSV的检测强调了监测地中海国家白蛉病毒传播和演变的重要性。
Various pathogens, including bacteria, fungi, parasites, and viruses can lead to meningitis. Among viruses causing meningitis, Toscana virus (TOSV), a phlebovirus, is transmitted through sandfly bites. TOSV infection may be suspected if patients with enterovirus- and herpesvirus-negative aseptic (non-bacterial) meningitis recall recent insect bites. Other epidemiological factors (season, rural area) may be considered. The broad range of possible meningitis aetiologies poses considerable diagnosis challenges. Untargeted metagenomic next-generation sequencing (mNGS) can potentially identify pathogens, which are not considered or detected in routine diagnostic panels. In this retrospective, single-centre observational study, we investigated mNGS usefulness to understand the cause of meningitis when conventional approaches fail. Cerebrospinal fluid (CSF) samples from patients hospitalised in southern Spain in 2015–2019 with aseptic meningitis and no aetiology found by conventional testing, were subjected to mNGS. Patients’ demographic characteristics had been recorded and physicians had asked them about recent insect bites. Obtained viral genome sequences were phylogenetically analysed. Among 23 idiopathic cases, TOSV was identified in eight (all male; median age: 39 years, range: 15–78 years). Five cases lived in an urban setting, three occurred in autumn and only one recalled insect bites. Phylogenetic analysis of TOSV segment sequences supported one intra-genotype reassortment event. Our study highlights the usefulness of mNGS for identifying viral pathogens directly in CSF. In southern Spain, TOSV should be considered regardless of recalling of insect bites or other epidemiological criteria. Detection of a disease-associated reassortant TOSV emphasises the importance of monitoring the spread and evolution of phleboviruses in Mediterranean countries.
DOI：
10.3390/v13081438
发表时间：
2021-07-23
期刊：
Viruses
影响因子：
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作者：
Sanbonmatsu-Gámez S;Pedrosa-Corral I;Navarro-Marí JM;Pérez-Ruiz M
通讯作者：
Pérez-Ruiz M