The metagenomic next-generation sequencing in diagnosing central nervous system angiostrongyliasis: a case report

BMC Infectious Diseases

Xunsha Sun¹  Rong Lai¹  Haiyan Wang¹  Hongyan Zhou¹  Cunzhou Shen¹  Huiyu Feng¹  Li Feng¹  Ling Chen¹  Aiwu Zhang²  Jiali Que³  Fuhua Peng⁴  Yuanlin Guan⁵ 

[1] Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China;Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China;Department of Intensive Care Unit, The Guangdong Second Provincial General Hospital, Guangzhou, China;Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China;Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China;Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China;Hugobiotech Co. Ltd, Beijing, China;

关键词: Angiostrongyliasis;    Eosinophilic meningoencephalitis;    Metagenomic next-generation sequencing;    Diagnosis;    Case report;   

DOI  :  10.1186/s12879-020-05410-y

来源: Springer

【 摘 要 】

BackgroundsThe incidence of angiostrongyliasis is increasing in recent decades due to the expanding endemic areas all over the world. Clinicians face tremendous challenge of diagnosing angiostrongyliasis because of the lack of awareness of the disease and less effective definitive laboratory tests.Case presentationA 27-year-old man initially manifested skin itching, emesis, myalgia and quadriparesis. With progressive weakness of four limbs and elevated protein in the cerebrospinal fluid (CSF), he was diagnosed as Guillain-Barré syndrome and treated with intravenous methylprednisolone and immunoglobulin. However, the patient deteriorated with hyperpyrexia, headache and then persistent coma. The routine tests for Angiostrongylus cantonensis (A. cantonensis) with both the CSF and the serum were all negative. In contrast, the metagenomic next-generation sequencing (mNGS) was applied with the serum sample and the CSF sample in the middle phase. The central nervous system (CNS) angiostrongyliasis was diagnosed by mNGS with the mid-phase CSF, but not the mid-phase serum. At the same time, the CSF analysis revealed eosinophils ratio up to 67%. The discovery of A. cantonensis was confirmed by PCR with CSF later. Unfortunately, the patient died of severe angiostrongyliasis. During his hospitalization, mNGS was carried out repeatedly after definitive diagnosis and targeted treatment. The DNA strictly map reads number of A. cantonensis detected by mNGS was positively correlated with the CSF opening pressure and clinical manifestations.ConclusionsThe case of A. cantonensis infection highlights the benefit of mNGS as a target-free identification in disclosing the rare CNS angiostrongyliasis in the unusual season, while solid evidence from routine clinical testing was absent. The appropriate sample of mNGS should be chosen according to the life cycle of A. cantonensis. Besides, given the fact that the DNA reads number of A. cantonensis fluctuated with CSF opening pressure and clinical manifestations, whether mNGS could be applied as a marker of effectiveness of treatment is worth further exploration.

【 授权许可】

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