Next generation sequencing based pathogen analysis in a patient with neurocysticercosis: a case report

Abstract

BackgroundAccurate and early diagnosis of neurocysticercosis (NCC) remains a challenge due to the heterogeneity of its clinical, immunological and imaging characteristics. The presence of cysticercus DNA in cerebrospinal fluid (CSF) of NCC patients has been previously detected via conventional PCR assays. To the best of our knowledge, the use of CSF Next-Generation Sequencing (NGS) based pathogen analysis in patients with NCC infection has never been reported.Case presentationThis study reports the clinical, imaging, and immunological features of a patient initially presenting with several months of headache who further developed a pure sensory stroke. NGS was used to detect the pathogen, and her CSF demonstrated the presence of Taenia solium-DNA. This finding was confirmed by a positive reaction to CSF cysticercosis antibodies. After antiparasitic treatment, secondary CSF NGS revealed the DNA index have dropped considerably compared to the initial NGS readings.ConclusionsNGS is a promising tool for the early and accurate diagnosis of central nervous system (CNS) infection, especially in the setting of atypical clinical manifestations. Further studies are required to evaluate the persistence of DNA in the CSF of patients.

Clinicopathology conference: 41‐year‐old woman with chronic relapsing meningitis

“…This case thus highlights the utility of mNGS for the diagnosis of atypical presentations of common infections. 24,68,69 The case also vividly illustrates that either improvement or lack of clinical deterioration in the setting of immunosuppression does not rule out an underlying infectious etiology, even after years of treatment.…”

Application of metagenomic next-generation sequencing for bronchoalveolar lavage diagnostics in critically ill patients

“…With the development of molecular biology, the value of whole genome-based next-generation sequencing (NGS) has gradually been recognized, especially for the detection of rare, atypical, or slow-growing microbes. NGS is mainly used in the clinical setting for assessment of sterile body fluids, including cerebrospinal fluid, blood, and joint effusion [1][2][3]. For non-sterile body fluids, such as sputum and bronchoalveolar lavage fluid (BALF), the applications of NGS are quite limited.…”

High‐Throughput Metagenomics for Identification of Pathogens in the Clinical Settings

“…[139] Further, mNGS also has values for the characterization of complex and rare pathogens present in culture-negative and undiagnosed cases. mNGS has been shown to help detect the presence of microbes, such as Listeria monocytogenes, [140] Brucellosis-causing species, [93,141] Naegleria fowleri, [142] neurocysticercosis-causing parasites, [143,144] and Vibrio vulnificus. [145] In CNS toxoplasmosis, mNGS may be useful in cases when the toxoplasmosis IgG is negative, CSF PCR is negative, and imaging is not classic, or when there is a lack of response to antitoxoplasmosis therapy.…”