Diagnosis of Two Meningitis Cases Caused by Rickettsia Felis in China, with Metagenomic Next-Generation Sequencing: A Case Report

Jie Wang,1,* Hong Zhou,2,* Zan Dong,3 Jing Wang,1 Rui Wang,1 Yuanlin Guan4 1Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, 030000, People’s Republic of China; 2Graduate School, the First Clinical School of Medicine, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 3Department of Neurology, Yuncheng Central Hospital, Yuncheng, 044000, People’s Republic of China; 4Department of Scientific Affairs, Hugobiotech Co, Ltd, Beijing, 100176, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jie Wang, Department of Neurology, First Hospital of Shanxi Medical University, No. 85 of Jiefang South Road, Taiyuan, Shanxi, 030000, People’s Republic of China, Tel +8613753198116, Email luwanglu2012@163.comBackground: Rickettsia felis is a kind of zoonotic pathogen. Rickettsia felis infections of the central nervous system are rare with only a few cases reported worldwide. The early diagnosis of R. felis is difficult due to its nonspecific clinical features and laboratory tests. Here, we report two meningitis cases caused by R. felis using metagenomic next-generation sequencing (mNGS).Methods: The clinical data of patients with meningitis who were diagnosed to have R. felis through cerebrospinal fluid culture, nuclear magnetic imaging, mNGS detection from January 2019 to December 2019 in The First Clinical Hospital of Shanxi Medical University, were retrospectively analyzed, and their clinical characteristics and disease regression findings were summarized.Case Presentation: The first case was a female patient aged 23 years who was admitted to our hospital presenting with symptoms of headache, fever, and weakness in both lower limbs. Upon examination of spinal imaging, myelitis was diagnosed. However, routine examination and culture of cerebrospinal fluid did not identify the pathogen responsible. Subsequently, metagenomic second-generation sequencing (mNGS) r