J Clin Neurol.  2016 Oct;12(4):446-451. 10.3988/jcn.2016.12.4.446.

Detection of Listeria monocytogenes in CSF from Three Patients with Meningoencephalitis by Next-Generation Sequencing

• Yao M
• Zhou J
• Zhu Y
• Zhang Y
• Lv X
• Sun R
• Shen A
• Ren H
• Cui L
• Guan H
• Wu H

• KMID: 2385109
• DOI: http://doi.org/10.3988/jcn.2016.12.4.446

Abstract

BACKGROUND AND PURPOSE
Encephalitis caused by Listeria monocytogenes (L. monocytogenes) is rare but sometimes fatal. Early diagnosis is difficult using routine cerebrospinal fluid (CSF) tests, while next-generation sequencing (NGS) is increasingly being used for the detection and characterization of pathogens.
METHODS
This study set up and applied unbiased NGS to detect L. monocytogenes in CSF collected from three cases of clinically suspected listeria meningoencephalitis.
RESULTS
Three cases of patients with acute/subacute meningoencephalitis are reported. Magnetic resonance imaging and blood cultures led to a suspected diagnosis of L. monocytogenes, while the CSF cultures were negative. Unbiased NGS of CSF identified and sequenced reads corresponding to L. monocytogenes in all three cases.
CONCLUSIONS
This is the first report highlighting the feasibility of applying NGS of CSF as a diagnostic method for central nervous system (CNS) L. monocytogenes infection. Routine application of this technology in clinical microbiology will significantly improve diagnostic methods for CNS infectious diseases.

Keyword

Listeria monocytogenes; meningoencephalitis; cerebrospinal fluid; next generation sequencing

MeSH Terms

Central Nervous System
Cerebrospinal Fluid
Communicable Diseases
Diagnosis
Early Diagnosis
Encephalitis
Humans
Listeria monocytogenes*
Listeria*
Magnetic Resonance Imaging
Meningitis, Listeria
Meningoencephalitis*
Methods

Figure

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  Fig. 1 Cranial magnetic resonance imaging of Case 1 (A and B) and Case 2 (C and D). A and B: Axial T2-weighted images showing irregular patchy hyperintense areas predominantly in the right lateral medullary and pons, and also in the cerebellar pedunculus. C: Sagittal T2-weighted image showing multiple patchy and nodular lesions with T2 prolongation involving the brainstem and upper cervical spinal cord. D: T1-weighted postcontrast image showing multiple parenchymal nodular and ring-enhanced lesions in the brainstem and upper cervical spinal cord.

• 

  Fig. 2 NGS results of pathogen identification. A: In Case 1, 0.75% of bacterial reads corresponded to L. monocytogenes, with a coverage of 0.28%. B: In Case 2, 39.14% of bacterial reads corresponded to L. monocytogenes, with a coverage of 2.4%. C: In Case 3, 66.39% of bacterial reads corresponded to L. monocytogenes, with a coverage of 1.9%. L. monocytogenes: Listeria monocytogenes, NGS: next-generation sequencing.

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