Enhanced Virus Detection and Metagenomic Sequencing in Patients with Meningitis and Encephalitis
ABSTRACT Meningitis and encephalitis are leading causes of central nervous system (CNS) disease and often result in severe neurological compromise or death. Traditional diagnostic workflows largely rely on pathogen-specific tests, sometimes over days to weeks, whereas metagenomic next-generation seq...
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American Society for Microbiology
2021
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oai:doaj.org-article:257d13788e6c45d0b65f5a35776fbd4c2021-11-10T18:37:51ZEnhanced Virus Detection and Metagenomic Sequencing in Patients with Meningitis and Encephalitis10.1128/mBio.01143-212150-7511https://doaj.org/article/257d13788e6c45d0b65f5a35776fbd4c2021-08-01T00:00:00Zhttps://journals.asm.org/doi/10.1128/mBio.01143-21https://doaj.org/toc/2150-7511ABSTRACT Meningitis and encephalitis are leading causes of central nervous system (CNS) disease and often result in severe neurological compromise or death. Traditional diagnostic workflows largely rely on pathogen-specific tests, sometimes over days to weeks, whereas metagenomic next-generation sequencing (mNGS) profiles all nucleic acid in a sample. In this single-center, prospective study, 68 hospitalized patients with known (n = 44) or suspected (n = 24) CNS infections underwent mNGS from RNA and DNA to identify potential pathogens and also targeted sequencing of viruses using hybrid capture. Using a computational metagenomic classification pipeline based on KrakenUniq and BLAST, we detected pathogen nucleic acid in cerebrospinal fluid (CSF) from 22 subjects, 3 of whom had no clinical diagnosis by routine workup. Among subjects diagnosed with infection by serology and/or peripheral samples, we demonstrated the utility of mNGS to detect pathogen nucleic acid in CSF, importantly for the Ixodes scapularis tick-borne pathogens Powassan virus, Borrelia burgdorferi, and Anaplasma phagocytophilum. We also evaluated two methods to enhance the detection of viral nucleic acid, hybrid capture and methylated DNA depletion. Hybrid capture nearly universally increased viral read recovery. Although results for methylated DNA depletion were mixed, it allowed the detection of varicella-zoster virus DNA in two samples that were negative by standard mNGS. Overall, mNGS is a promising approach that can test for multiple pathogens simultaneously, with efficacy similar to that of pathogen-specific tests, and can uncover geographically relevant infectious CNS disease, such as tick-borne infections in New England. With further laboratory and computational enhancements, mNGS may become a mainstay of workup for encephalitis and meningitis. IMPORTANCE Meningitis and encephalitis are leading global causes of central nervous system (CNS) disability and mortality. Current diagnostic workflows remain inefficient, requiring costly pathogen-specific assays and sometimes invasive surgical procedures. Despite intensive diagnostic efforts, 40 to 60% of people with meningitis or encephalitis have no clear cause of CNS disease identified. As diagnostic uncertainty often leads to costly inappropriate therapies, the need for novel pathogen detection methods is paramount. Metagenomic next-generation sequencing (mNGS) offers the unique opportunity to circumvent these challenges using unbiased laboratory and computational methods. Here, we performed comprehensive mNGS from 68 prospectively enrolled patients with known (n = 44) or suspected (n = 24) CNS viral infection from a single center in New England and evaluated enhanced methods to improve the detection of CNS pathogens, including those not traditionally identified in the CNS by nucleic acid detection. Overall, our work helps elucidate how mNGS can become integrated into the diagnostic toolkit for CNS infections.Anne PiantadosiShibani S. MukerjiSimon YeMichael J. LeoneLisa M. FreimarkDaniel ParkGordon AdamsJacob LemieuxSanjat KanjilalIsaac H. SolomonAsim A. AhmedRobert GoldsteinVijay GaneshBridget OstremKaelyn C. CumminsJesse M. ThonCormac M. KinsellaEric RosenbergMatthew P. FroschMarcia B. GoldbergTracey A. ChoPardis SabetiAmerican Society for Microbiologyarticleencephalitismetagenomic sequencingnext-generation sequencing (NGS)meningitisvirushybrid captureMicrobiologyQR1-502ENmBio, Vol 12, Iss 4 (2021) |
| institution |
DOAJ |
| collection |
DOAJ |
| language |
EN |
| topic |
encephalitis metagenomic sequencing next-generation sequencing (NGS) meningitis virus hybrid capture Microbiology QR1-502 |
| spellingShingle |
encephalitis metagenomic sequencing next-generation sequencing (NGS) meningitis virus hybrid capture Microbiology QR1-502 Anne Piantadosi Shibani S. Mukerji Simon Ye Michael J. Leone Lisa M. Freimark Daniel Park Gordon Adams Jacob Lemieux Sanjat Kanjilal Isaac H. Solomon Asim A. Ahmed Robert Goldstein Vijay Ganesh Bridget Ostrem Kaelyn C. Cummins Jesse M. Thon Cormac M. Kinsella Eric Rosenberg Matthew P. Frosch Marcia B. Goldberg Tracey A. Cho Pardis Sabeti Enhanced Virus Detection and Metagenomic Sequencing in Patients with Meningitis and Encephalitis |
| description |
ABSTRACT Meningitis and encephalitis are leading causes of central nervous system (CNS) disease and often result in severe neurological compromise or death. Traditional diagnostic workflows largely rely on pathogen-specific tests, sometimes over days to weeks, whereas metagenomic next-generation sequencing (mNGS) profiles all nucleic acid in a sample. In this single-center, prospective study, 68 hospitalized patients with known (n = 44) or suspected (n = 24) CNS infections underwent mNGS from RNA and DNA to identify potential pathogens and also targeted sequencing of viruses using hybrid capture. Using a computational metagenomic classification pipeline based on KrakenUniq and BLAST, we detected pathogen nucleic acid in cerebrospinal fluid (CSF) from 22 subjects, 3 of whom had no clinical diagnosis by routine workup. Among subjects diagnosed with infection by serology and/or peripheral samples, we demonstrated the utility of mNGS to detect pathogen nucleic acid in CSF, importantly for the Ixodes scapularis tick-borne pathogens Powassan virus, Borrelia burgdorferi, and Anaplasma phagocytophilum. We also evaluated two methods to enhance the detection of viral nucleic acid, hybrid capture and methylated DNA depletion. Hybrid capture nearly universally increased viral read recovery. Although results for methylated DNA depletion were mixed, it allowed the detection of varicella-zoster virus DNA in two samples that were negative by standard mNGS. Overall, mNGS is a promising approach that can test for multiple pathogens simultaneously, with efficacy similar to that of pathogen-specific tests, and can uncover geographically relevant infectious CNS disease, such as tick-borne infections in New England. With further laboratory and computational enhancements, mNGS may become a mainstay of workup for encephalitis and meningitis. IMPORTANCE Meningitis and encephalitis are leading global causes of central nervous system (CNS) disability and mortality. Current diagnostic workflows remain inefficient, requiring costly pathogen-specific assays and sometimes invasive surgical procedures. Despite intensive diagnostic efforts, 40 to 60% of people with meningitis or encephalitis have no clear cause of CNS disease identified. As diagnostic uncertainty often leads to costly inappropriate therapies, the need for novel pathogen detection methods is paramount. Metagenomic next-generation sequencing (mNGS) offers the unique opportunity to circumvent these challenges using unbiased laboratory and computational methods. Here, we performed comprehensive mNGS from 68 prospectively enrolled patients with known (n = 44) or suspected (n = 24) CNS viral infection from a single center in New England and evaluated enhanced methods to improve the detection of CNS pathogens, including those not traditionally identified in the CNS by nucleic acid detection. Overall, our work helps elucidate how mNGS can become integrated into the diagnostic toolkit for CNS infections. |
| format |
article |
| author |
Anne Piantadosi Shibani S. Mukerji Simon Ye Michael J. Leone Lisa M. Freimark Daniel Park Gordon Adams Jacob Lemieux Sanjat Kanjilal Isaac H. Solomon Asim A. Ahmed Robert Goldstein Vijay Ganesh Bridget Ostrem Kaelyn C. Cummins Jesse M. Thon Cormac M. Kinsella Eric Rosenberg Matthew P. Frosch Marcia B. Goldberg Tracey A. Cho Pardis Sabeti |
| author_facet |
Anne Piantadosi Shibani S. Mukerji Simon Ye Michael J. Leone Lisa M. Freimark Daniel Park Gordon Adams Jacob Lemieux Sanjat Kanjilal Isaac H. Solomon Asim A. Ahmed Robert Goldstein Vijay Ganesh Bridget Ostrem Kaelyn C. Cummins Jesse M. Thon Cormac M. Kinsella Eric Rosenberg Matthew P. Frosch Marcia B. Goldberg Tracey A. Cho Pardis Sabeti |
| author_sort |
Anne Piantadosi |
| title |
Enhanced Virus Detection and Metagenomic Sequencing in Patients with Meningitis and Encephalitis |
| title_short |
Enhanced Virus Detection and Metagenomic Sequencing in Patients with Meningitis and Encephalitis |
| title_full |
Enhanced Virus Detection and Metagenomic Sequencing in Patients with Meningitis and Encephalitis |
| title_fullStr |
Enhanced Virus Detection and Metagenomic Sequencing in Patients with Meningitis and Encephalitis |
| title_full_unstemmed |
Enhanced Virus Detection and Metagenomic Sequencing in Patients with Meningitis and Encephalitis |
| title_sort |
enhanced virus detection and metagenomic sequencing in patients with meningitis and encephalitis |
| publisher |
American Society for Microbiology |
| publishDate |
2021 |
| url |
https://doaj.org/article/257d13788e6c45d0b65f5a35776fbd4c |
| work_keys_str_mv |
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| _version_ |
1718439759527804928 |