Department of Clinical Microbiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Infectious Diseases, Wallenberg Centre for Molecular and Translational Medicine, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
Sci Rep. 2022 Mar 1;12(1):3378. doi: 10.1038/s41598-022-07260-x.
Infection in the central nervous system is a severe condition associated with high morbidity and mortality. Despite ample testing, the majority of encephalitis and meningitis cases remain undiagnosed. Metagenomic sequencing of cerebrospinal fluid has emerged as an unbiased approach to identify rare microbes and novel pathogens. However, several major hurdles remain, including establishment of individual limits of detection, removal of false positives and implementation of universal controls. Twenty-one cerebrospinal fluid samples, in which a known pathogen had been positively identified by available clinical techniques, were subjected to metagenomic DNA sequencing. Fourteen samples contained minute levels of Epstein-Barr virus. The detection threshold for each sample was calculated by using the total leukocyte content in the sample and environmental contaminants found in the bioinformatic classifiers. Virus sequences were detected in all ten samples, in which more than one read was expected according to the calculations. Conversely, no viral reads were detected in seven out of eight samples, in which less than one read was expected according to the calculations. False positive pathogens of computational or environmental origin were readily identified, by using a commonly available cell control. For bacteria, additional filters including a comparison between classifiers removed the remaining false positives and alleviated pathogen identification. Here we show a generalizable method for identification of pathogen species using DNA metagenomic sequencing. The choice of bioinformatic method mainly affected the efficiency of pathogen identification, but not the sensitivity of detection. Identification of pathogens requires multiple filtering steps including read distribution, sequence diversity and complementary verification of pathogen reads.
中枢神经系统感染是一种严重的疾病,发病率和死亡率都很高。尽管进行了大量的检测,但大多数脑炎和脑膜炎病例仍未得到诊断。脑脊液的宏基因组测序已成为一种识别罕见微生物和新型病原体的无偏方法。然而,仍存在几个主要障碍,包括建立个体检测限、去除假阳性和实施通用对照。对 21 份脑脊液样本进行了宏基因组 DNA 测序,这些样本中的已知病原体已通过现有临床技术得到了阳性鉴定。其中 14 份样本含有微量的 EBV(Epstein-Barr virus,爱泼斯坦-巴尔病毒)。每个样本的检测阈值是通过使用样本中的总白细胞含量和生物信息学分类器中发现的环境污染物来计算的。根据计算,预计有超过一个读取的 10 个样本中均检测到了病毒序列。相反,根据计算,预计读取数量小于一个的 8 个样本中均未检测到病毒序列。通过使用常见的细胞对照,可以很容易地识别出计算或环境来源的假阳性病原体。对于细菌,包括分类器之间比较在内的其他过滤方法去除了其余的假阳性,并缓解了病原体的鉴定。在这里,我们展示了一种使用 DNA 宏基因组测序鉴定病原体种属的通用方法。生物信息学方法的选择主要影响病原体鉴定的效率,而不影响检测的灵敏度。病原体的鉴定需要包括读取分布、序列多样性和病原体读取的互补验证在内的多个过滤步骤。