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Clinical Metagenomic Sequencing for Diagnosis of Meningitis and Encephalitis
Open accessAbstract
BACKGROUND: Metagenomic next-generation sequencing (NGS) of cerebrospinal fluid (CSF) has the potential to identify a broad range of pathogens in a single test. METHODS: In a 1-year, multicenter, prospective study, we investigated the usefulness of metagenomic NGS of CSF for the diagnosis of infectious meningitis and encephalitis in hospitalized patients. All positive tests for pathogens on metagenomic NGS were confirmed by orthogonal laboratory testing. Physician feedback was elicited by teleconferences with a clinical microbial sequencing board and by surveys. Clinical effect was evaluated by retrospective chart review. RESULTS: We enrolled 204 pediatric and adult patients at eight hospitals. Patients were severely ill: 48.5% had been admitted to the intensive care unit, and the 30-day mortality among all study patients was 11.3%. A total of 58 infections of the nervous system were diagnosed in 57 patients (27.9%). Among these 58 infections, metagenomic NGS identified 13 (22%) that were not identified by clinical testing at the source hospital. Among the remaining 45 infections (78%), metagenomic NGS made concurrent diagnoses in 19. Of the 26 infections not identified by metagenomic NGS, 11 were diagnosed by serologic testing only, 7 were diagnosed from tissue samples other than CSF, and 8 were negative on metagenomic NGS owing to low titers of pathogens in CSF. A total of 8 of 13 diagnoses made solely by metagenomic NGS had a likely clinical effect, with 7 of 13 guiding treatment. CONCLUSIONS: Routine microbiologic testing is often insufficient to detect all neuroinvasive pathogens. In this study, metagenomic NGS of CSF obtained from patients with meningitis or encephalitis improved diagnosis of neurologic infections and provided actionable information in some cases. (Funded by the National Institutes of Health and others; PDAID ClinicalTrials.gov number, NCT02910037.).
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“Metagenomic next-generation sequencing (mNGS) to detect microbial cell-free DNA (mcfDNA) in plasma is a promising approach, potentially allowing earlier detection and diagnosis of fungal infections when other blood biomarkers/tests are still negative.23”
From Epidemiology of Invasive Candidiasis (2024) · cites this paper as [23]
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“In fact, mNGS was able to identify 16 pathogens that could not otherwise be detected by routine methods (35), attesting to its robustness and sensitivity.”
From Viruses Causing Aseptic Meningitis: A Tertiary Medical Center Experience With a Multiplex PCR Assay (2020) · cites this paper as [35]
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“A new emerging technique that might be very broad yet highly accurate at detection is the mNGS, which has been shown to detect more neuroinvasive viruses accurately (32, 35).”
From Viruses Causing Aseptic Meningitis: A Tertiary Medical Center Experience With a Multiplex PCR Assay (2020) · cites this paper as [35]
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Additional file 4 of The genomic alterations in glioblastoma influence the levels of CSF metabolites
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Additional file 5 of The genomic alterations in glioblastoma influence the levels of CSF metabolites
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Additional file 1 of The genomic alterations in glioblastoma influence the levels of CSF metabolites
Wang, D. H., Fujita, Y., Dono, A., Rodriguez-Armendariz, A. G., Shah, M., Putluri, N., Pichardo-Rojas, P. S., Patel, C. B., Zhu, J.-J., Huse, J. T., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26669862
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Additional file 2 of The genomic alterations in glioblastoma influence the levels of CSF metabolites
Wang, D. H., Fujita, Y., Dono, A., Rodriguez-Armendariz, A. G., Shah, M., Putluri, N., Pichardo-Rojas, P. S., Patel, C. B., Zhu, J.-J., Huse, J. T., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26669865
Gan, M., Zhang, Y., Yan, G., Wang, Y., Lu, G., Wu, B., Chen, W., & Zhou, W. (2024) · Figshare · doi:10.6084/m9.figshare.25609283
Additional file 3 of The genomic alterations in glioblastoma influence the levels of CSF metabolites
Wang, D. H., Fujita, Y., Dono, A., Rodriguez-Armendariz, A. G., Shah, M., Putluri, N., Pichardo-Rojas, P. S., Patel, C. B., Zhu, J.-J., Huse, J. T., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26669868
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Additional file 6 of The genomic alterations in glioblastoma influence the levels of CSF metabolites
Wang, D. H., Fujita, Y., Dono, A., Rodriguez-Armendariz, A. G., Shah, M., Putluri, N., Pichardo-Rojas, P. S., Patel, C. B., Zhu, J.-J., Huse, J. T., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26669877
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Metadata
- Authors
- Wilson, M. R., Sample, H. A., Zorn, K. C., Arevalo, S., Yu, G., Neuhaus, J., Federman, S., Stryke, D., Briggs, B., Langelier, C., Berger, A., Douglas, V., Josephson, S. A., Chow, F. C., Fulton, B. D., DeRisi, J. L., Gelfand, J. M., Naccache, S. N., Bender, J., Dien Bard, J., Murkey, J., Carlson, M., Vespa, P. M., Vijayan, T., Allyn, P. R., Campeau, S., Humphries, R. M., Klausner, J. D., Ganzon, C. D., Memar, F., Ocampo, N. A., Zimmermann, L. L., Cohen, S. H., Polage, C. R., DeBiasi, R. L., Haller, B., Dallas, R., Maron, G., Hayden, R., Messacar, K., Dominguez, S. R., Miller, S., & Chiu, C. Y.
- Affiliations
- University of California, San Francisco (US)
- Children's Hospital Los Angeles (US)
- From the Departments of Neurology (M.R.W., V.D., S.A.J., F.C.C., J.M.G.), Biochemistry and Biophysics (H.A.S., K.C.Z., J.L.D.), Laboratory Medicine (S.A., G.Y., S.F., D.S., B.B., B.H., S.M., C.Y.C.), and Epidemiology and Biostatistics (J.N.), the Department of Medicine, Division of Infectious Diseases (C.L., C.Y.C.), the Department of Medicine, Division of Hospital Medicine (A.B.), and Weill Institute for Neurosciences (M.R.W., V.D., S.A.J., F.C.C., J.M.G.), University of California, San Francisco ...
- University of California, Los Angeles (US)
- Children's National (US)
- San Francisco General Hospital (US)
- St. Jude Children's Research Hospital (US)
- ORCID
- Wilson, Michael R.
- Sample, Hannah A.
- Zorn, Kelsey C.
- Yu, Guixia
- Neuhaus, John
- Federman, Scot
- Briggs, Benjamin
- Langelier, Charles
- Douglas, Vanja
- Josephson, S. Andrew
- Chow, Felicia C.
- Fulton, Brent D.
- DeRisi, Joseph L.
- Gelfand, Jeffrey M.
- Naccache, Samia N.
- Bender, Jeffrey
- Murkey, Jamie
- Vijayan, Tara
- Allyn, Paul R.
- Humphries, Romney M.
- Klausner, Jeffrey D.
- Cohen, Stuart H.
- Polage, Christopher R.
- DeBiasi, Roberta L.
- Dallas, Ronald
- Hayden, Randall
- Messacar, Kevin
- Dominguez, Samuel R.
- Miller, Steve
- Chiu, Charles Y.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2019-06-13
- Volume
- 380
- Issue
- 24
- Pages
- 2327-2340
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC6764751
- OpenAlex
- W2953017819
- Cited by
- 1,067
- References
- 27
- Citations by year
- 2026: 148 · 2025: 152 · 2024: 149 · 2023: 151 · 2022: 164 · 2021: 146 · 2020: 116 · 2019: 39
- FWCI
- 83.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute of Neurological Disorders and Stroke (K08NS096117)
- National Heart, Lung, and Blood Institute (HL105704, U54HL119893)
- California Initiative to Advance Precision Medicine
- National Center for Advancing Translational Sciences (UL1TR000004)
- Bowes Foundation
- Charles and Helen Schwab Foundation
- Sandler Foundation
- Rachleff Family Endowment
- Chan Zuckerberg Biohub
- George and Judy Marcus Innovation Fund
- Topics
- Health Sciences › Medicine › Microbiology (medical) › Bacterial Identification and Susceptibility Testing
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Keywords
- metagenomic sequencing, cerebrospinal fluid, infectious meningitis, encephalitis, neuroinvasive infection, pathogen detection, clinical microbiology, telemedicine, physician feedback, pediatric patients, intensive care unit admission
- MeSH terms
- Adolescent, Adult, Cerebrospinal Fluid, Child, Child, Preschool, Encephalitis, Female, Humans, Infant, Infections, Length of Stay, Male, Meningitis, Meningoencephalitis, Middle Aged, Myelitis, Prospective Studies, Sequence Analysis, DNA, Sequence Analysis, RNA, Young Adult, Metagenomics, High-Throughput Nucleotide Sequencing, Genome, Microbial
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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