51. The Feasibility of Metagenomic Next-Generation Sequencing to Identify Pathogens Causing Tuberculous Meningitis in Cerebrospinal Fluid
- Author
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Yongjun Li, Yingli Chen, Deqiang Zhao, Suyue Pan, Yanping Gong, Guanghui Liu, Yingwei Huang, Wei Li, Yongming Wu, Hongzhi Guan, Yafang Hu, Kaibin Huang, Shengnan Wang, Xuan Li, Jianzhao Zhang, Xifang Nie, Ruixue Sun, Haishan Jiang, Dongmei Wang, Hui-fang Xie, and Jian Zhang
- Subjects
Microbiology (medical) ,medicine.medical_specialty ,lcsh:QR1-502 ,Gastroenterology ,Stain ,Microbiology ,Tuberculous meningitis ,cerebrospinal fluid ,lcsh:Microbiology ,law.invention ,Mycobacterium tuberculosis ,03 medical and health sciences ,law ,Internal medicine ,medicine ,Polymerase chain reaction ,030304 developmental biology ,Original Research ,Cryptococcus neoformans ,0303 health sciences ,biology ,030306 microbiology ,business.industry ,meningitis ,biology.organism_classification ,medicine.disease ,metagenomic next-generation sequencing ,Mycobacterium tuberculosis complex ,business ,Meningitis ,Encephalitis ,early diagnosis - Abstract
Purpose The application of metagenomic next-generation sequencing (mNGS) in the diagnosis of tuberculous meningitis (TBM) remains poorly characterized. Here, we retrospectively analyzed data from patients with TBM who had taken both mNGS and conventional tests including culture of Mycobacterium tuberculosis (MTB), polymerase chain reaction (PCR) and acid-fast bacillus (AFB) stain, and the sensitivity and specificity of these methods were compared. Methods We retrospectively recruited TBM patients admitted to the hospital between December 2015 and October 2018. The first collection of cerebrospinal fluid (CSF) samples underwent both mNGS and conventional tests. In addition, patients with bacterial/cryptococcal meningitis or viral meningoencephalitis were mNGS positive controls, and a patient with auto-immune encephalitis was an mNGS negative control. Results Twenty three TBM patients were classified as 12 definite and 11 clinical diagnoses, which were based on clinical manifestations, pathogen evidence, CSF parameters, brain imaging, and treatment response. The mNGS method identified sequences of Mycobacterium tuberculosis complex (MBTC) from 18 samples (18/23, 78.26%). In patients with definite TBM, the sensitivity of mNGS, AFB, PCR, and culture to detect MTB in the first CSF samples were 66.67, 33.33, 25, and 8.33%, respectively. The specificity of each method was 100%. Among the four negative mNGS cases (4/23, 17.39%), three turned out positive by repeated AFB stain. The agreement of mNGS with the total of conventional methods was 44.44% (8/18). Combination of mNGS and conventional methods increased the detection rate to 95.65%. One patient was diagnosed as complex of TBM and cryptococcal meningitis, in which AFB stain and cryptococcal antigen enzyme immunoassay were positive and the DNA of Cryptococcus neoformans was detected by mNGS. Conclusion Our study indicates that mNGS is an alternative method to detect the presence of mycobacterial DNA in CSF samples from patients with TBM and deserves to be applied as a front-line CSF test.
- Published
- 2019
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