Diagnosis of osteoarticular tuberculosis via metagenomic next‑generation sequencing: A case report

Abstract

Osteoarticular tuberculosis (OAT) may cause severe complications and disability. Due to its indolent nature, OAT is difficult to diagnose in the early stages. Diagnosis by conventional culture is time-consuming and insensitive, and polymerase chain reaction-based molecular diagnostic methods are incapable of excluding co-infections. Metagenomic next-generation sequencing (mNGS) may identify a broad spectrum of microorganisms, including Mycobacterium, bacteria and fungi, in clinical specimens. Therefore, the diagnosis of OAT may be rapidly performed using mNGS. The present study reports on a case of OAT. The patient presented with right knee swelling and pain for 1 year; his C-reactive protein levels and erythrocyte sedimentation rate were markedly elevated. Although multiple pre-operative cultures were negative, mNGS was finally used to successfully detect the underlying pathogen. The result was confirmed by other molecular biology methods and Mycobacterium culture. Anti-tuberculosis therapy was administered accordingly and the patient finally recovered. In conclusion mNGS, with the ability to detect Mycobacterium and other microorganisms in a single assay, is an emerging approach for rapidly and accurately diagnosing OAT. This method may provide significant support to guide physicians in selecting the appropriate pharmacotherapy and surgical treatments.

Tuberculosis Diagnosis by Metagenomic Next-generation Sequencing on Bronchoalveolar Lavage Fluid: a cross-sectional analysis

“…It is anticipated that within the next decade, detection and characterization of pathogens via metagenomics-based workflows will be routine in diagnostic and public health laboratories (Forbes et al, 2017). However, published reports describing the usefulness of mNGS in patients with TB are limited to individual patients or small case series (Zhou et al, 2019;Sinkov et al, 2019;Wang et al, 2019;Ai et al, 2018;Huang et al, 2019). Little is known about the sensitivity and clinical utility of mNGS for the diagnosis of pulmonary TB compared with conventional tests.…”

Case Report: Metagenomic Next-Generation Sequencing in Diagnosis of Disseminated Tuberculosis of an Immunocompetent Patient

“…Just like the biopsies in our case, histopathological examination sometimes only shows granulomas without typical caseous necrosis, which is non-specific for the diagnosis of TB. PCR is a valuable diagnostic technique, but it always requires presupposing specific pathogens, which sometimes cannot detect rare pathogens and mixed infections ( 21 ). Additionally, Xpert MTB/RIF, a new automated molecular test, has been endorsed by WHO for the initial detection of TB and rifampicin resistance ( 14 ).…”

Total Knee Arthroplasty in Patients with Unsuspected Tuberculosis of the Joint: A Report of Four Cases and a Systematic Review of the Literature

“…In a case of knee joint infection, Huang et al . identified the pathogen as M. tuberculosis complex using metagenomic next‐generation sequencing 61 . Using this technique, one case in our study was diagnosed as a multi‐bacterial mixed infection that included M. tuberculosis .…”

“…Second-generation sequencing is a relatively new technique for identifying pathogens, and is more advantageous for multi-bacterial infections. In a case of knee joint infection, Huang et al identified the pathogen as M. tuberculosis complex using metagenomic next-generation sequencing 61 . Using this technique, one case in our study was diagnosed as a multi-bacterial mixed infection that included M. tuberculosis.…”