Next-generation sequencing of cerebrospinal fluid for the diagnosis of neurocysticercosis

Xiaofei Fei,Yining Yang,Ying He,Jian Shi,Gang Zhao,Ting Bian,Yun Zhang,Fang Du,Ming Shi,Na Liu,Yajun Shi,Tingting Liu,Guodong Feng,Chaoyang Li,Xingyue An,Xinchao Ji,Wen Dai,Zheng Cai,Xuewu Liu,Zhang Hong-Ya ,Meng‐Hao Wu ,Huanjiao Jenny Zhou

doi:10.1016/j.clineuro.2020.105752

Abstract

ObjectiveNeurocysticercosis (NCC) is the most common parasitic disease of the human central nervous system (CNS). However, a diagnosis of NCC may be hard to make if the specific clinical and routine neuroimaging manifestations are lacking, which hinders physicians from considering further immunodiagnostic tests. Patients and methodsSeven patients presented with fever, headache, nausea, cognitive decline, confusion, or progressive leg weakness. There were no pathogens found in the cerebrospinal fluid (CSF); patients were clinically suspected of meningoencephalitis or cerebrovascular disease. To clearly determine the etiology, next generation sequencing (NGS) of the CSF was used to detect pathogens in these seven patients. ResultsTaenia solium DNA sequences were detected in the seven patients, but not in the non-template controls (NTCs) or the other patients with clinically suspected CNS infections. Based on the patients' medical data and the diagnostic criteria for NCC, seven patients were diagnosed with probable NCC. The unique reads aligning to Taenia solium ranged from 6 to 261064, with genomic coverage ranging from 0.0003% to 14.8079%. The number of unique reads and genomic coverage dropped in three of the seven patients after antiparasitic treatment, consistent with the relief of symptoms. ConclusionThis study showed that NGS of the CSF might be an auxiliary diagnostic method for NCC patients. Larger studies are required.

Highlights

Neurocysticercosis (NCC) is an infection of the central nervous system (CNS) and its meningeal coverings caused by the larval stage of the tapeworm Taenia solium [1]
Of the 381 patients with clinically suspected CNS infections, four patients with NCC were identified by NGS of CSF
All four patients were diagnosed with probable neurocysticercosis according to the diagnostic criteria for NCC [5]

Summary

Introduction

Neurocysticercosis (NCC) is an infection of the central nervous system (CNS) and its meningeal coverings caused by the larval stage of the tapeworm Taenia solium [1]. It is endemic in resourcelimited areas where pigs are raised. The clinical manifestations and neuroimaging findings of NCC vary greatly due to factors such as the number, stage, size, and location of parasites in the nervous system [4]. Neurocysticercosis (NCC) is the most common helminthic infection of the central nervous system (CNS). The diagnosis of NCC is sometimes challenging due to its heterogenous clinical manifestations and the variable sensitivity and specificity of neuroimaging and serological tests

Methods

Results

Conclusion