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Metagenomic Analysis of Silage
Published on: January 13, 2017
Diagnosis of primary amoebic meningoencephalitis by metagenomic next-generation sequencing: A case report
Xiujuan Che1, Zhiyi He1, Tao-Hsin Tung2
1Department of Neurology, Neurointensive Care Unit, The Maoming People's Hospital, Maoming 525000, Guangdong Province, China.
Abstract:
Primary amoebic meningoencephalitis (PAM) caused by Naegleria fowleri is a fatal infection with a mortality rate of more than 95%, despite advances in antimicrobial chemotherapy and supportive care. Initial manifestations of PAM are indistinguishable from bacterial meningitis. Prompt diagnosis and antifungal treatment may help decline the overall mortality. Here we present a case of a 38-year-old man transferred to our hospital due to mild headache, which deteriorated quickly. Severe increased intracranial pressure was found. The cerebrospinal fluid (CSF) was yellowish with significantly increased leukocyte and protein. Smear and culture were negative. The patient was first diagnosed with pyogenic meningoencephalitis. However, the symptoms deteriorated. Metagenomic next-generation sequencing (mNGS) of CSF was applied and finally confirmed N. fowleri as the protist pathogen within 24 h. However, due to the time cost of sampling and transportation (2 days), the diagnosis came too late, and the patient passed away 1 day before. In summary, mNGS is a rapid and accurate diagnostic method for clinical practices, especially for rare central nervous system infections. It should be used as quickly as possible for acute infections, such as PAM. All aspects of patient interrogation and prompt identification should be paramount to ensure appropriate treatment and decline the overall mortality.
Insights
Primary amoebic meningoencephalitis (PAM), a rare and fatal infection caused by Naegleria fowleri, requires rapid diagnosis. Metagenomic next-generation sequencing (mNGS) offers a swift and accurate method for identifying PAM pathogens, potentially improving patient outcomes.
Area of Science:
- Neurology
- Infectious Diseases
- Molecular Diagnostics
Background:
- Primary amoebic meningoencephalitis (PAM) caused by Naegleria fowleri is a rare, devastating central nervous system infection with a >95% mortality rate.
- Early PAM symptoms mimic bacterial meningitis, complicating prompt diagnosis and treatment initiation.
- Despite advances in supportive care, effective treatments for PAM remain limited.
Observation:
- A case study of a 38-year-old male presenting with headache, rapidly progressing to severe increased intracranial pressure.
- Cerebrospinal fluid analysis revealed elevated leukocytes and protein, with negative smear and culture results, initially suggesting pyogenic meningitis.
- Metagenomic next-generation sequencing (mNGS) of CSF identified Naegleria fowleri within 24 hours, confirming the PAM diagnosis.
Findings:
- mNGS provides rapid and accurate pathogen identification for central nervous system infections, including rare protist infections like PAM.
- Diagnostic delays, including sample transportation time, can significantly impact patient outcomes in rapidly progressing infections.
- The case highlights the potential of mNGS in diagnosing challenging neurological infections.
Implications:
- Early and rapid implementation of mNGS is crucial for diagnosing acute infections such as PAM.
- Streamlining diagnostic workflows, from sample collection to mNGS analysis, can improve patient survival rates.
- Enhanced patient interrogation and prompt identification of pathogens are paramount for effective PAM management and reducing mortality.
