Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Scientific Affairs, Hugobiotech Co., Ltd., Beijing, China.
Front Cell Infect Microbiol. 2022 Apr 21;12:831959. doi: 10.3389/fcimb.2022.831959. eCollection 2022.
Metagenomic next-generation sequencing (mNGS) has been applied more and more widely for the diagnosis of infectious diseases, but its performance in the diagnosis of cryptococcal meningitis (CM) remains unclear.
Cerebrospinal fluid (CSF) samples from 197 HIV-negative patients with suspected central nervous system infections were tested simultaneously by mNGS and routine methods [India ink staining, fungal culture, or cryptococcal antigen (CrAg) tests]. The performance of mNGS was evaluated.
Of the 197 enrolled cases, 46 (23.4%) cases were finally diagnosed with CM, including 43 (93.5%) s infections and 3 (6.5%) infections. The sensitivity, specificity, positive predictive value, negative predictive value, and concordance rate of mNGS were 93.5% [95% confidence interval (CI) at 86.4%100.0%], 96.0% (95% CI at 92.9%99.1%), 87.8%, 98.0%, and 95.4%, respectively. Comparing to the conventional diagnostic methods, the sensitivity and concordance rate of mNGS were slightly lower than those of CrAg tests (97.4%) but higher than those of India ink (63.0%) and culture (76.7%). Besides, mNGS had a sensitivity of 100.0% against culture. It should be noted that mNGS could identify at species level; of the 3 cases was only distinguished by mNGS.
CSF mNGS can be considered as a supplementary test to diagnose CM and directly distinguish from s in clinical specimens.
宏基因组下一代测序（mNGS）已越来越多地应用于传染病的诊断，但它在隐球菌性脑膜炎（CM）诊断中的性能仍不清楚。
对 197 例疑似中枢神经系统感染的 HIV 阴性患者的脑脊液（CSF）样本同时进行 mNGS 和常规方法[印度墨汁染色、真菌培养或隐球菌抗原（CrAg）检测]检测。评估 mNGS 的性能。
197 例纳入病例中，最终诊断为 CM 的有 46 例（23.4%），其中 s 感染 43 例（93.5%）， 感染 3 例（6.5%）。mNGS 的灵敏度、特异度、阳性预测值、阴性预测值和符合率分别为 93.5%（95%CI 为 86.4%100.0%）、96.0%（95%CI 为 92.9%99.1%）、87.8%、98.0%和 95.4%。与传统诊断方法相比，mNGS 的灵敏度和符合率略低于 CrAg 检测（97.4%），但高于印度墨汁（63.0%）和培养（76.7%）。此外，mNGS 对培养的灵敏度为 100.0%。需要注意的是，mNGS 可以在物种水平上识别 ；3 例中的仅通过 mNGS 区分。
CSF mNGS 可作为辅助诊断 CM 的检测手段，并可直接从临床标本中区分 和 s。
