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Human pegivirus identified in severe myelitis and optic neuritis in immunocompromised patients: A pathogenic role for
N Valyraki1, E Maillart2, V Pourcher3
1Service de Neurologie 2-Mazarin, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau Et de La Moelle Épinière, ICM, Assistance publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié-Salpêtrière-Charles-Foix, Paris, France; Service de Neurologie, Hôpital Fondation Adolphe-de-Rothschild, 25-29, rue Manin, 75940 Paris cedex 19, France.
Abstract:
The role of Human pegivirus (HPgV) in patients with encephalitis has been recently questioned. We present cases of 4 patients with similar clinical, biological, and radiological characteristics, including a past history of transplantation with long-term immunosuppression and a progressive course of severe and predominantly myelitis, associated in 3 cases with optic neuropathy causing blindness. Extensive workup was negative but analysis of the CSF by use of pan-microorganism DNA- and RNA-based shotgun metagenomics was positive for HPgV. This case series further supports the hypothesis of HPgV CNS infection and highlights the utility of metagenomic next-generation sequencing of CSF in immunocompromised patients.
Insights
Human pegivirus (HPgV) may cause central nervous system (CNS) infections, particularly in immunocompromised patients. Metagenomic sequencing of cerebrospinal fluid (CSF) identified HPgV in patients with unexplained myelitis and optic neuropathy.
Area of Science:
- Neurology
- Infectious Diseases
- Virology
Background:
- The role of Human pegivirus (HPgV) in neurological conditions remains unclear.
- Encephalitis and myelitis are serious neurological disorders often requiring extensive investigation.
- Immunocompromised patients, such as transplant recipients, are susceptible to opportunistic infections.
Purpose of the Study:
- To investigate the potential role of HPgV in a series of patients presenting with severe neurological symptoms.
- To evaluate the diagnostic utility of advanced sequencing techniques in identifying causative agents in complex neurological cases.
Main Methods:
- Case series of 4 patients with progressive myelitis and optic neuropathy.
- Comprehensive etiological workup including cerebrospinal fluid (CSF) analysis.
- Pan-microorganism DNA- and RNA-based shotgun metagenomic sequencing of CSF.
Main Results:
- Standard investigations were negative for known pathogens.
- Metagenomic sequencing detected HPgV in the CSF of all 4 patients.
- Patients presented with severe myelitis and, in 3 cases, optic neuropathy leading to blindness.
Conclusions:
- This case series provides further evidence supporting HPgV as a causative agent of CNS infections.
- Metagenomic next-generation sequencing is a valuable tool for diagnosing infections in immunocompromised patients with neurological symptoms.
- HPgV should be considered in the differential diagnosis of unexplained myelitis and optic neuropathy, especially in transplant recipients.
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