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Case Reports
. 2020 Feb 19;20(1):159.
doi: 10.1186/s12879-020-4872-8.

Fulminant central nervous system varicella-zoster virus infection unexpectedly diagnosed by metagenomic next-generation sequencing in an HIV-infected patient: a case report

Mingxia Fang  1 , Xing Weng  2 , Liyun Chen  3 , Yaling Chen  1 , Yun Chi  1 , Wei Chen  4 , Zhiliang Hu  5   6
Affiliations
Case Reports

Fulminant central nervous system varicella-zoster virus infection unexpectedly diagnosed by metagenomic next-generation sequencing in an HIV-infected patient: a case report

Mingxia Fang et al. BMC Infect Dis. .

Abstract

Background: Varicella-zoster virus (VZV) infection can be diagnosed clinically once classical rash occurs but the diagnosis is challenging when typical rash is absent. We reported a case of fulminant central nervous system (CNS) VZV infection in a human immunodeficiency virus (HIV)-infected patient without typical VZV-related rash. CNS VZV infection was unexpected identified by metagenomic next-generation sequencing (mNGS).

Case presentation: A 28-year-old HIV-infected patient presented with neurological symptoms for 3 days. The patient, who was not suspected of VZV infection at admission, quickly progressed to deep coma during the first 24 h of hospitalization. An unbiased mNGS was performed on DNA extract from 300 μL cerebrospinal fluid (CSF) with the BGISEQ-50 platform. The sequencing detection identified 97,248 (out of 38,561,967) sequence reads uniquely aligned to the VZV genome, and these reads covered a high percentage (99.91%) of the VZV. Presence of VZV DNA in CSF was further verified by VZV-specific polymerase chain reaction and Sanger sequencing. Altogether, those results confirmed CNS VZV infection.

Conclusions: This study suggests that mNGS may be a useful diagnostic tool for CNS VZV infection. As mNGS could identify all pathogens directly from CSF sample in a single run, it has the promise of strengthening our ability to diagnose CNS infections in HIV-infected patients.

Keywords: Central nervous system infection; Metagenomic next-generation sequencing; Varicella-zoster virus.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Skin lesion on patient’s left foot. There was a superficial ulcer on the dorsum of the left foot with partial necrosis and black crust, surrounded by a cluster of blisters
Fig. 2
Fig. 2
Analysis of sequencing result of varicella-zoster virus using the metagenomic next-generation sequencing. a Reads distribution of total DNA in the cerebrospinal fluid samples. b Reads distribution of all non-human reads
Fig. 3
Fig. 3
Polymerase chain reaction detection of varicella-zoster virus. Lane 1: 89-bp polymerase chain reaction product of varicella-zoster virus; Lane M: DNA ladder; Lane N: Negative control
See this image and copyright information in PMC

References

    1. Johnson RW. Herpes zoster and postherpetic neuralgia. Exp Rev Vaccines. 2010;9(sup3):21–26. doi: 10.1586/erv.10.30. - DOI - PubMed
    1. Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D, Grose C, Hambleton S, Kennedy PG, Oxman MN, et al. Varicella zoster virus infection. Nat Rev Dis Primers. 2015;1:15016. doi: 10.1038/nrdp.2015.16. - DOI - PMC - PubMed
    1. Simner PJ, Miller S, Carroll KC. Understanding the promises and hurdles of metagenomic next-generation sequencing as a diagnostic tool for infectious diseases. Clin Infect Dis. 2018;66(5):778–788. doi: 10.1093/cid/cix881. - DOI - PMC - PubMed
    1. Hu Z, Weng X, Xu C, Lin Y, Cheng C, Wei H, Chen W. Metagenomic next-generation sequencing as a diagnostic tool for toxoplasmic encephalitis. Ann Clin Microbiol Antimicrob. 2018;17(1):45. doi: 10.1186/s12941-018-0298-1. - DOI - PMC - PubMed
    1. Li H, Durbin R. Fast and accurate short read alignment with burrows-wheeler transform. Bioinformatics. 2009;25(14):1754–1760. doi: 10.1093/bioinformatics/btp324. - DOI - PMC - PubMed

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