High-throughput sequencing for the aetiologic identification of viral encephalitis, meningoencephalitis, and meningitis. A narrative review and clinical appraisal

Abstract

a b s t r a c tBackground: Viral aetiologies are the most common cause of central nervous system (CNS) infections. Approximately one-half of CNS infections remain of undetermined origin. High-throughput sequencing (HTS) brought new perspectives to CNS infection investigations, allowing investigation of viral aetiologies with an unbiased approach. HTS use is still limited to specific clinical situations. Objectives: The aim of this review was to evaluate the contribution and pitfalls of HTS for the aetiologic identification of viral encephalitis, meningoencephalitis, and meningitis in CNS patient samples. Sources: PubMed was searched from 1 January 2008 to 2 August 2018 to retrieve available studies on the topic. Additional publications were included from a review of full-text sources. Content: Among 366 studies retrieved, 29 used HTS as a diagnostic technique. HTS was performed in cerebrospinal fluid and brain biopsy samples of 307 patients, including immunocompromised, immunocompetent paediatric, and adult cases. HTS was performed retrospectively in 18 studies and prospectively in 11. HTS led to the identification of a potential causal virus in 41 patients, with 11 viruses known and ten not expected to cause CNS infections. Various HTS protocols were used. Implications: The additional value of HTS is difficult to quantify because of various biases. Nevertheless, HTS led to the identification of a viral cause in 13% of encephalitis, meningoencephalitis, and meningitis cases in which various assays failed to identify the cause. HTS should be considered early in clinical management as a complement to routine assays. Standardized strategies and systematic studies are needed for the integration of HTS in clinical management. M.-C. Zanella, Clin Microbiol Infect 2019;25:422

Advances in molecular diagnostic testing for central nervous system infections

“…Steady progress is being made in reducing the number of gaps, and it is recognised that this involves different diagnostic approaches, as well as earlier and improved sampling of cases. (15). Summary of viruses identified using high-throughput sequencing (and / or subsequent confirmatory assays) in CSF and brain biopsy samples of 41 patients with suspected viral CNS infection, separated by immune status and clinical manifestations.…”

Etiology of Central Nervous System Infections in a Rural Area of Nepal Using Molecular Approaches

“…As this study together with several others could not find the causative pathogens in a majority of patients, by using conventional or molecular testing, this calls for a wider approach of the methods used, including metagenomic techniques. 35–37…”

Diagnostic approach to encephalitis and meningoencephalitis in adult returning travellers

“…Contrarily to the pathogen specific screening approach with routine testing, High throughput sequencing (HTS) potentially enables the detection of any pathogen present in a given sample, including identification of previously unknown pathogens. We suggest that HTS should be considered, when available, for encephalitis with unknown origin in returning travellers [92].…”