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Published on: March 22, 2012
Diagnostic performance of noncultural methods for central nervous system aspergillosis
Ling-Hong Zhou1, Rong-Sheng Zhu1, Yan-Ping Gong2
1Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.
Background:
Central nervous system (CNS) aspergillosis is an uncommon but fatal disease, the diagnosis of which is still difficult.
Objectives:
We aim to explore the diagnositic performance of noncultural methods for CNS aspergillosis.
Methods:
In this retrospective study, all pathologically confirmed rhinosinusitis patients in whom cerebrospinal fluid (CSF) galactomannan (GM) test and metagenomic next-generation sequencing (mNGS) had been performed were included. We evaluated the diagnostic performances of CSF GM optical density indexes (ODI) at different cut-off values and compared performance with mNGS in patients with and without CNS aspergillosis, as well as in patients with different manifestations of CNS aspergillosis.
Results:
Of the 21 proven and probable cases, one had positive culture result, five had positive mNGS results and 10 had a CSF GM ODI of >0.7. Sample concordance between mNGS and GM test was poor, but best diagnostic performance was achieved by combination of GM test (ODI of >0.7) and mNGS, which generated a sensitivity of 61.9% and specificity of 82.6%. Further investigation of combination diagnostic performances in different kind of CNS aspergillosis was also conducted. Lowest sensitivity (42.9%) was identified in abscess group, while increased sensitivity (60.0%) was achieved in abscess with encephalitis groups. Combination test exhibited the best performance for encephalitis patients who had only CSF abnormalities, in whom the sensitivity and specificity were 77.8% and 82.6%, respectively.
Conclusions:
In conclusion, combination of these two tests might be useful for diagnosis of CNS aspergillosis associated with fungal rhinosinusitis, especially in encephalitis patients.
Insights
Diagnosing central nervous system (CNS) aspergillosis is challenging. Combining cerebrospinal fluid (CSF) galactomannan (GM) testing with metagenomic next-generation sequencing (mNGS) improves diagnostic accuracy, particularly for encephalitis cases.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Neurology
Background:
- Central nervous system (CNS) aspergillosis is a rare but often fatal infection.
- Accurate and timely diagnosis of CNS aspergillosis remains a significant clinical challenge.
Purpose of the Study:
- To evaluate the diagnostic performance of noncultural diagnostic methods for CNS aspergillosis.
- To compare the efficacy of cerebrospinal fluid (CSF) galactomannan (GM) testing and metagenomic next-generation sequencing (mNGS) in diagnosing CNS aspergillosis.
Main Methods:
- Retrospective analysis of pathologically confirmed rhinosinusitis patients who underwent CSF GM testing and mNGS.
- Evaluation of CSF GM optical density index (ODI) at various cut-off values.
- Comparison of diagnostic performance between individual tests and their combination, stratified by CNS aspergillosis presence and clinical manifestations.
Main Results:
- Among 21 proven/probable cases, CSF GM was positive in 10, and mNGS in 5. Culture was positive in only one case.
- The combination of CSF GM (ODI >0.7) and mNGS achieved the highest diagnostic performance with 61.9% sensitivity and 82.6% specificity.
- Diagnostic sensitivity varied by clinical presentation, with the lowest in the abscess group (42.9%) and highest in encephalitis patients (77.8% sensitivity, 82.6% specificity) when using the combined approach.
Conclusions:
- The combination of CSF GM testing and mNGS offers a valuable diagnostic strategy for CNS aspergillosis, especially in patients with fungal rhinosinusitis.
- This combined approach demonstrates particular utility in diagnosing CNS aspergillosis presenting as encephalitis.
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