Next generation sequencing for diagnosis of central nervous system aspergillosis in liver transplant recipients.

BACKGROUND

Fungal encephalitis is uncommon and sometimes fatal in liver transplant (LT) recipients. Early diagnosis of central nervous system (CNS) fungal infections, especially aspergillosis, is difficult based on routine tests of cerebrospinal fluid (CSF) alone. Next-generation sequencing (NGS) as a new tool may help in this respect.

METHODS

Shotgun metagenomics was used to detect pathogens in CSF of patients, who were clinically suspected of CNS infection. Sequencing was performed at BGIseq-50 platform (BGI, Shenzhen).

RESULTS

NGS technique identified in CSF of 5 patients, who were suspected of CNS infection, although clinical symptoms of these patients varied dramatically. The resulting sequence reads corresponding to species ranged from 2 to 25, with genomic coverage ranging from 0.0003% to 0.0036%. Rapid identification of enabled early appropriate antifungal therapy, although 4 patients eventually died of severe infection.

CONCLUSIONS

This is the first study to highlight the utility of NGS in early diagnosis of CNS aspergillosis in LT recipients. This new tool may be helpful in improving the diagnosis of CNS aspergillosis.