Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China; Department of Internal Medicine, Shanghai Medical College, Fudan University, Shanghai, China; Department of Infectious Diseases, Huashan Hospital Affiliated to Fudan University, Shanghai, China.
Int J Infect Dis. 2021 Jun;107:139-144. doi: 10.1016/j.ijid.2021.04.057. Epub 2021 Apr 20.
To evaluate the clinical utility of metagenomic next-generation sequencing (mNGS) for the diagnosis of central nervous system (CNS) infection in people living with human immunodeficiency virus (PLWH) in a real-world situation.
Cerebrospinal fluid (CSF) was sent for mNGS for PLWH who tested negative on all conventional tests but were still suspected to have CNS infection. A retrospective analysis was undertaken of the results and the clinical effect of mNGS on this cohort. The final diagnosis was adjudicated by a panel discussion following hospital discharge when the results of all tests and patients' responses to the empiric therapy were available.
Eighty-eight eligible PLWH, including 51 (58%) patients suspected of encephalitis and 34 (46.7%) patients suspected of meningitis, were included in the analysis. Sixty-eight (77.3%) patients were diagnosed with CNS infection, of which 50 were based on the pathogens identified by mNGS. The most common disease missed by mNGS was clinically suspected tuberculous meningitis, followed by clinically suspected non-tuberculous mycobacterial meningitis. The results from mNGS led to modification of treatment in 21 (23.9%) patients, and increased confidence in continuation of original therapy in 30 (34.1%) patients. During hospitalization, two (2.3%) patients died and 66 (75%) patients improved.
mNGS of CSF is a useful tool for the diagnosis of CNS infection among PLWH. Further investigations are warranted to improve its sensitivity.
评估宏基因组下一代测序（mNGS）在实际情况下对人类免疫缺陷病毒（PLWH）患者中枢神经系统（CNS）感染的临床应用价值。
对所有常规检测均为阴性但仍疑似 CNS 感染的 PLWH 进行脑脊液 mNGS 检测。对该队列的检测结果和 mNGS 的临床效果进行回顾性分析。当所有检测结果和患者对经验性治疗的反应可用时，通过出院后专家组讨论来确定最终诊断。
共纳入 88 名符合条件的 PLWH，包括 51 名（58%）疑似脑炎患者和 34 名（46.7%）疑似脑膜炎患者。68 名（77.3%）患者被诊断为 CNS 感染，其中 50 名基于 mNGS 鉴定的病原体。mNGS 最容易漏诊的疾病是临床疑似结核性脑膜炎，其次是临床疑似非结核分枝杆菌性脑膜炎。mNGS 的结果导致 21 名（23.9%）患者的治疗方案发生改变，30 名（34.1%）患者对原治疗方案的信心增强。住院期间，有 2 名（2.3%）患者死亡，66 名（75%）患者病情改善。
CSF 的 mNGS 是诊断 PLWH 中枢神经系统感染的有用工具。需要进一步研究以提高其灵敏度。
