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Metagenomics for neurological infections — expanding our imagination

Over the past two decades, the diagnosis rate for patients with encephalitis has remained poor despite advances in pathogen-specific testing such as PCR and antigen assays. Metagenomic next-generation sequencing (mNGS) of RNA and DNA extracted from cerebrospinal fluid and brain tissue now offers ano...

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Autores principales: Ramachandran, Prashanth S., Wilson, Michael R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356134/
https://www.ncbi.nlm.nih.gov/pubmed/32661342
http://dx.doi.org/10.1038/s41582-020-0374-y
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author Ramachandran, Prashanth S.
Wilson, Michael R.
author_facet Ramachandran, Prashanth S.
Wilson, Michael R.
author_sort Ramachandran, Prashanth S.
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description Over the past two decades, the diagnosis rate for patients with encephalitis has remained poor despite advances in pathogen-specific testing such as PCR and antigen assays. Metagenomic next-generation sequencing (mNGS) of RNA and DNA extracted from cerebrospinal fluid and brain tissue now offers another strategy for diagnosing neurological infections. Given that mNGS simultaneously assays for a wide range of infectious agents in an unbiased manner, it can identify pathogens that were not part of a neurologist’s initial differential diagnosis either because of the rarity of the infection, because the microorganism has not been previously associated with a clinical phenotype or because it is a newly discovered organism. This Review discusses the technical advantages and pitfalls of cerebrospinal fluid mNGS in the context of patients with neuroinflammatory syndromes, including encephalitis, meningitis and myelitis. We also speculate on how mNGS testing potentially fits into current diagnostic testing algorithms given data on mNGS test performance, cost and turnaround time. Finally, the Review highlights future directions for mNGS technology and other hypothesis-free testing methodologies that are in development.
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spelling pubmed-73561342020-07-13 Metagenomics for neurological infections — expanding our imagination Ramachandran, Prashanth S. Wilson, Michael R. Nat Rev Neurol Review Article Over the past two decades, the diagnosis rate for patients with encephalitis has remained poor despite advances in pathogen-specific testing such as PCR and antigen assays. Metagenomic next-generation sequencing (mNGS) of RNA and DNA extracted from cerebrospinal fluid and brain tissue now offers another strategy for diagnosing neurological infections. Given that mNGS simultaneously assays for a wide range of infectious agents in an unbiased manner, it can identify pathogens that were not part of a neurologist’s initial differential diagnosis either because of the rarity of the infection, because the microorganism has not been previously associated with a clinical phenotype or because it is a newly discovered organism. This Review discusses the technical advantages and pitfalls of cerebrospinal fluid mNGS in the context of patients with neuroinflammatory syndromes, including encephalitis, meningitis and myelitis. We also speculate on how mNGS testing potentially fits into current diagnostic testing algorithms given data on mNGS test performance, cost and turnaround time. Finally, the Review highlights future directions for mNGS technology and other hypothesis-free testing methodologies that are in development. Nature Publishing Group UK 2020-07-13 2020 /pmc/articles/PMC7356134/ /pubmed/32661342 http://dx.doi.org/10.1038/s41582-020-0374-y Text en © Springer Nature Limited 2020 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Review Article
Ramachandran, Prashanth S.
Wilson, Michael R.
Metagenomics for neurological infections — expanding our imagination
title Metagenomics for neurological infections — expanding our imagination
title_full Metagenomics for neurological infections — expanding our imagination
title_fullStr Metagenomics for neurological infections — expanding our imagination
title_full_unstemmed Metagenomics for neurological infections — expanding our imagination
title_short Metagenomics for neurological infections — expanding our imagination
title_sort metagenomics for neurological infections — expanding our imagination
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356134/
https://www.ncbi.nlm.nih.gov/pubmed/32661342
http://dx.doi.org/10.1038/s41582-020-0374-y
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