Department of Neurology, Hainan Hospital of PLA General Hospital, Sanya, China.
Department of Neurology, First Medical Center of PLA General Hospital, Beijing, China.
Front Cell Infect Microbiol. 2020 Mar 5;10:88. doi: 10.3389/fcimb.2020.00088. eCollection 2020.
We assessed the performance of metagenomic next-generation sequencing (mNGS) in the diagnosis of infectious encephalitis and meningitis. This was a prospective multicenter study. Cerebrospinal fluid samples from patients with viral encephalitis and/or meningitis, tuberculous meningitis, bacterial meningitis, fungal meningitis, and non-central nervous system (CNS) infections were subjected to mNGS. In total, 213 patients with infectious and non-infectious CNS diseases were finally enrolled from November 2016 to May 2019; the mNGS-positive detection rate of definite CNS infections was 57.0%. At a species-specific read number (SSRN) ≥2, mNGS performance in the diagnosis of definite viral encephalitis and/or meningitis was optimal (area under the curve [AUC] = 0.659, 95% confidence interval [CI] = 0.566-0.751); the positivity rate was 42.6%. At a genus-specific read number ≥1, mNGS performance in the diagnosis of tuberculous meningitis (definite or probable) was optimal (AUC=0.619, 95% CI=0.516-0.721); the positivity rate was 27.3%. At SSRNs ≥5 or 10, the diagnostic performance was optimal for definite bacterial meningitis (AUC=0.846, 95% CI = 0.711-0.981); the sensitivity was 73.3%. The sensitivities of mNGS (at SSRN ≥2) in the diagnosis of cryptococcal meningitis and cerebral aspergillosis were 76.92 and 80%, respectively. mNGS of cerebrospinal fluid effectively identifies pathogens causing infectious CNS diseases. mNGS should be used in conjunction with conventional microbiological testing. Chinese Clinical Trial Registry, ChiCTR1800020442.
我们评估了宏基因组下一代测序（mNGS）在诊断感染性脑炎和脑膜炎中的性能。这是一项前瞻性多中心研究。对病毒性脑炎和/或脑膜炎、结核性脑膜炎、细菌性脑膜炎、真菌性脑膜炎和非中枢神经系统（CNS）感染患者的脑脊液样本进行了 mNGS 检测。2016 年 11 月至 2019 年 5 月，共纳入 213 例感染性和非感染性中枢神经系统疾病患者；明确中枢神经系统感染的 mNGS 阳性检出率为 57.0%。在物种特异性读长数（SSRN）≥2 时，mNGS 对明确病毒性脑炎和/或脑膜炎的诊断性能最佳（曲线下面积[AUC] = 0.659，95%置信区间[CI] = 0.566-0.751）；阳性率为 42.6%。在属特异性读长数≥1 时，mNGS 对结核性脑膜炎（明确或可能）的诊断性能最佳（AUC=0.619，95%CI=0.516-0.721）；阳性率为 27.3%。在 SSRN≥5 或 10 时，mNGS 对明确细菌性脑膜炎的诊断性能最佳（AUC=0.846，95%CI=0.711-0.981）；敏感性为 73.3%。mNGS（在 SSRN≥2 时）对隐球菌性脑膜炎和脑曲霉病的诊断敏感性分别为 76.92%和 80%。mNGS 可有效鉴定引起感染性中枢神经系统疾病的病原体。mNGS 应与常规微生物检测相结合使用。中国临床试验注册中心，ChiCTR1800020442。
