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Chen F, Zhao Y, Shen C, Han L, Chen X, Zhang J, Xia Q, Qian Y. Next generation sequencing for diagnosis of central nervous system aspergillosis in liver transplant recipients. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1071. [PMID: 34422983 PMCID: PMC8339870 DOI: 10.21037/atm-21-92] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/08/2021] [Indexed: 01/19/2023]
Abstract
Background Fungal encephalitis is uncommon and sometimes fatal in liver transplant (LT) recipients. Early diagnosis of central nervous system (CNS) fungal infections, especially aspergillosis, is difficult based on routine tests of cerebrospinal fluid (CSF) alone. Next-generation sequencing (NGS) as a new tool may help in this respect. Methods Shotgun metagenomics was used to detect pathogens in CSF of patients, who were clinically suspected of CNS infection. Sequencing was performed at BGIseq-50 platform (BGI, Shenzhen). Results NGS technique identified Aspergillus in CSF of 5 patients, who were suspected of CNS infection, although clinical symptoms of these patients varied dramatically. The resulting sequence reads corresponding to Aspergillus species ranged from 2 to 25, with genomic coverage ranging from 0.0003% to 0.0036%. Rapid identification of Aspergillus enabled early appropriate antifungal therapy, although 4 patients eventually died of severe infection. Conclusions This is the first study to highlight the utility of NGS in early diagnosis of CNS aspergillosis in LT recipients. This new tool may be helpful in improving the diagnosis of CNS aspergillosis.
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Affiliation(s)
- Fang Chen
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yujing Zhao
- Department of Anesthesiology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Chuan Shen
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Longzhi Han
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiaosong Chen
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jianjun Zhang
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qiang Xia
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yongbing Qian
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Ridha M, Jones DG, Lerner DP, Vytopil M, Voetsch B, Burns JD, Ramineni A, Raibagkar P. The spectrum of Epstein-Barr virus infections of the central nervous system after organ transplantation. Virol J 2021; 18:162. [PMID: 34362398 PMCID: PMC8343950 DOI: 10.1186/s12985-021-01629-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epstein-Barr virus (EBV)-related neurologic complications have a diverse presentation in transplant recipients, creating diagnostic and therapeutic challenges for clinicians. In this case series, we report unique manifestations of EBV related neurologic complications following solid organ transplant and highlight pitfalls in management. CASE PRESENTATIONS A retrospective search of the electronic medical record of all patients from January 2015 to December 2020 who underwent solid organ transplantation and had central nervous system complications as determined by ICD-10 codes were included. Three patients with unique manifestation of EBV-related neurologic complications after liver transplantation were identified. The first was a 52-year-old man with a live-donor liver transplant 11 years prior for Budd-Chiari syndrome presented with several weeks of headache and several lesions on brain MRI; he was diagnosed with primary central nervous system post-transplant lymphoproliferative disorder. The second patient was a 63-year-old man with a deceased-donor liver transplant 16 years prior for alpha-1-antitrypsin deficiency and was found to have a stroke; he was diagnosed with EBV encephalitis. The final patient was a 75-year-old woman with a deceased-donor liver transplant six years prior for primary biliary cirrhosis who presented with four months of gait instability; she was diagnosed with EBV myelitis. A review of the literature was performed to supplement description of the different diseases. CONCLUSIONS EBV-related central nervous infection in post-transplant patients can manifest in a variety of neurologic syndromes, which can be challenging to diagnose. Careful correlation of clinical, pathologic, and radiologic findings and a high index of suspicion are crucial in identification and appropriate management.
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Affiliation(s)
- Mohamed Ridha
- Department of Neurology, University of Cincinnati, 260 Stetson, Suite 2300, Cincinnati, OH, 45267, USA.
| | - Dylan G Jones
- Division of Neurology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA.,Department of Neurology, Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA
| | - David P Lerner
- Division of Neurology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA.,Department of Neurology, Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA
| | - Michal Vytopil
- Division of Neurology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA.,Department of Neurology, Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA
| | - Barbara Voetsch
- Division of Neurology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA.,Department of Neurology, Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA
| | - Joseph D Burns
- Division of Neurology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA.,Department of Neurology, Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA
| | - Anil Ramineni
- Division of Neurology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA.,Department of Neurology, Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA
| | - Pooja Raibagkar
- Concord Hospital Neurology Associates, 246 Pleasant Street, Concord, NH, 03301, USA
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Matthews E, Diaz-Arias LA, Beekmann SE, Polgreen P, Waldrop G, Yang V, Rimmer K, Venkatesan A, Thakur KT. Prevalence and Characteristics of Neuroinfectious Disease Inquiries Within the Emerging Infections Network: A 22-Year Retrospective Study. Open Forum Infect Dis 2020; 7:ofaa163. [PMID: 32550236 PMCID: PMC7292246 DOI: 10.1093/ofid/ofaa163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/01/2020] [Indexed: 11/14/2022] Open
Abstract
Background To monitor emerging infectious diseases, the Centers for Disease Control and Prevention and the Infectious Disease Society of America established the Emerging Infections Network (EIN), allowing infectious disease specialists to post inquiries about clinical cases. We describe the frequency and characteristics of neuroinfectious disease-related inquiries. Methods The EIN listserv was retrospectively reviewed from February 1997 to December 2019 using search terms associated with neurologic diseases. We recorded case summaries, disease type (ie, meningitis, encephalitis), inquiry type (diagnostic approach, result interpretation, management decisions), unique patient populations, exposures, pathogens, ultimate diagnosis, and change in clinical care based on responses. Results Of 2348 total inquiries, 285 (12.1%) related to neuroinfectious diseases. The majority involved meningitis (99, 34.7%) or encephalitis (56, 19.6%). One hundred fifteen inquiries (40%) related to management, 34 (12%) related to diagnostic workup, and 22 (8%) related to result interpretation. Eight (2.8%) specifically involved results of cerebrospinal fluid polymerase chain reaction testing. Sixty-three (22.1%) involved immunosuppressed patients (29 human immunodeficiency virus-positive cases [46%]). The most common pathogens were Treponema pallidum (19, 6.7%) and Cryptococcus neoformans (18, 6.3%). In 74 (25%) inquiries, patients had neurologic symptoms without a clear infection, 38 (51.3%) of which included noninfectious neurologic etiologies in the differential diagnosis. Conclusions This study demonstrates the significant challenges of diagnosis and management of neuroinfectious diseases within the field of infectious diseases. It also highlights the importance of curated forums to guide the approach of difficult cases, in particular instances that mimic infectious diseases. Finally, the EIN listserv may assist in identifying areas for research and training to address these complexities.
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Affiliation(s)
- Elizabeth Matthews
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Luisa A Diaz-Arias
- Johns Hopkins Encephalitis Center, Division of Neuroimmunology and Neuroinfectious Diseases, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan E Beekmann
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Philip Polgreen
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Greer Waldrop
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Vivian Yang
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Kathryn Rimmer
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Arun Venkatesan
- Johns Hopkins Encephalitis Center, Division of Neuroimmunology and Neuroinfectious Diseases, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kiran T Thakur
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
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Weidauer S, Wagner M, Enkirch SJ, Hattingen E. CNS Infections in Immunoincompetent Patients : Neuroradiological and Clinical Features. Clin Neuroradiol 2019; 30:9-25. [PMID: 31538219 DOI: 10.1007/s00062-019-00837-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/28/2019] [Indexed: 12/15/2022]
Abstract
In patients with immunodeficiency the pathogen spectrum of central nervous system (CNS) infections is broader and different from that of immunocompetent patients. Numerous opportunistic infections are characterized by a high prevalence of viral, bacterial and parasitic pathogens, and depend on the type of impaired immune defense, for example impaired T‑cell or monocyte function, monoclonal antibody treatment, and impaired granulocyte function. Neuroradiological features as well as laboratory findings are often different and versatile in comparison to immunocompetent individuals and pathognomonic imaging findings do not exist; however, knowledge of possible pathways of pathogens in the CNS and preferred tissue affection may help in narrowing down differential diagnoses. Therefore, knowledge of the type of patient and the performed immunomodulatory therapy is essential for the neuroradiological assessment and the differential diagnostic considerations. Moreover, parenchymal reactions in the sense of an immune reconstitution inflammatory syndrome (IRIS) can occur when immunocompetence is restored. This review focus on the most common pathologies in immunocompromised patients, and an overview of imaging features but also of pathology and clinical aspects is given. The synopsis of anamnestic information, clinical findings and structured analysis of the lesion pattern, its spread and short-term follow-up may increase the correct diagnostic classification; however, the gold standard is still determination of the pathogen in the cerebrospinal fluid (CSF), blood cultures or biopsies.
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Affiliation(s)
- Stefan Weidauer
- Department of Neurology, Sankt Katharinen Hospital, Teaching Hospital, Goethe University, Seckbacher Landstraße 65, 60389, Frankfurt/Main, Germany.
| | - Marlies Wagner
- Institute of Neuroradiology, Goethe University, Frankfurt am Main, Germany
| | | | - Elke Hattingen
- Institute of Neuroradiology, Goethe University, Frankfurt am Main, Germany
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