Format

Send to

Choose Destination
Ann Neurol. 2015 Nov;78(5):722-30. doi: 10.1002/ana.24499. Epub 2015 Aug 24.

Diagnosing Balamuthia mandrillaris Encephalitis With Metagenomic Deep Sequencing.

Author information

1
Department of Biochemistry and Biophysics, University of California, San Francisco, CA.
2
Department of Neurology, University of California, San Francisco, CA.
3
Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA.
4
Koc University, Istanbul, Turkey.
5
Free-Living and Intestinal Amebas Laboratory, Centers for Disease Control and Prevention, Atlanta, GA.
6
Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA.
7
California Department of Public Health, Viral and Rickettsial Disease Laboratory, Richmond, CA.
8
Department of Pathology, Division of Neuropathology, University of California, San Francisco, CA.
9
Howard Hughes Medical Institute, Chevy Chase, MD.

Abstract

OBJECTIVE:

Identification of a particular cause of meningoencephalitis can be challenging owing to the myriad bacteria, viruses, fungi, and parasites that can produce overlapping clinical phenotypes, frequently delaying diagnosis and therapy. Metagenomic deep sequencing (MDS) approaches to infectious disease diagnostics are known for their ability to identify unusual or novel viruses and thus are well suited for investigating possible etiologies of meningoencephalitis.

METHODS:

We present the case of a 74-year-old woman with endophthalmitis followed by meningoencephalitis. MDS of her cerebrospinal fluid (CSF) was performed to identify an infectious agent.

RESULTS:

Sequences aligning to Balamuthia mandrillaris ribosomal RNA genes were identified in the CSF by MDS. Polymerase chain reaction subsequently confirmed the presence of B. mandrillaris in CSF, brain tissue, and vitreous fluid from the patient's infected eye. B. mandrillaris serology and immunohistochemistry for free-living amoebas on the brain biopsy tissue were positive.

INTERPRETATION:

The diagnosis was made using MDS after the patient had been hospitalized for several weeks and subjected to costly and invasive testing. MDS is a powerful diagnostic tool with the potential for rapid and unbiased pathogen identification leading to early therapeutic targeting.

PMID:
26290222
PMCID:
PMC4624031
DOI:
10.1002/ana.24499
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wiley Icon for PubMed Central
Loading ...
Support Center