Acute West Nile Virus Meningoencephalitis Diagnosed Via Metagenomic Deep Sequencing of Cerebrospinal Fluid in a Renal Transplant Patient

M. R. Wilson, Lara Zimmermann, E. D. Crawford, H. A. Sample, P. R. Soni, A. N. Baker, L. M. Khan, J. L. DeRisi

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Solid organ transplant patients are vulnerable to suffering neurologic complications from a wide array of viral infections and can be sentinels in the population who are first to get serious complications from emerging infections like the recent waves of arboviruses, including West Nile virus, Chikungunya virus, Zika virus, and Dengue virus. The diverse and rapidly changing landscape of possible causes of viral encephalitis poses great challenges for traditional candidate-based infectious disease diagnostics that already fail to identify a causative pathogen in approximately 50% of encephalitis cases. We present the case of a 14-year-old girl on immunosuppression for a renal transplant who presented with acute meningoencephalitis. Traditional diagnostics failed to identify an etiology. RNA extracted from her cerebrospinal fluid was subjected to unbiased metagenomic deep sequencing, enhanced with the use of a Cas9-based technique for host depletion. This analysis identified West Nile virus (WNV). Convalescent serum serologies subsequently confirmed WNV seroconversion. These results support a clear clinical role for metagenomic deep sequencing in the setting of suspected viral encephalitis, especially in the context of the high-risk transplant patient population.

Original languageEnglish (US)
Pages (from-to)803-808
Number of pages6
JournalAmerican Journal of Transplantation
Volume17
Issue number3
DOIs
StatePublished - Mar 1 2017

Fingerprint

High-Throughput Nucleotide Sequencing
Metagenomics
West Nile virus
Meningoencephalitis
Viral Encephalitis
Cerebrospinal Fluid
Transplants
Kidney
Chikungunya virus
Arboviruses
Dengue Virus
Virus Diseases
Encephalitis
Serology
Immunosuppression
Nervous System
Population
Communicable Diseases
RNA
Infection

Keywords

  • basic (laboratory) research/science
  • clinical research/practice
  • diagnostic techniques and imaging
  • genetics
  • genomics
  • infection and infectious agents
  • infectious disease
  • kidney (allograft) function/dysfunction
  • kidney transplantation/nephrology
  • viral: Epstein-Barr Virus (EBV)
  • viral: West Nile, infection and infectious agents

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Acute West Nile Virus Meningoencephalitis Diagnosed Via Metagenomic Deep Sequencing of Cerebrospinal Fluid in a Renal Transplant Patient. / Wilson, M. R.; Zimmermann, Lara; Crawford, E. D.; Sample, H. A.; Soni, P. R.; Baker, A. N.; Khan, L. M.; DeRisi, J. L.

In: American Journal of Transplantation, Vol. 17, No. 3, 01.03.2017, p. 803-808.

Research output: Contribution to journalArticle

Wilson, M. R. ; Zimmermann, Lara ; Crawford, E. D. ; Sample, H. A. ; Soni, P. R. ; Baker, A. N. ; Khan, L. M. ; DeRisi, J. L. / Acute West Nile Virus Meningoencephalitis Diagnosed Via Metagenomic Deep Sequencing of Cerebrospinal Fluid in a Renal Transplant Patient. In: American Journal of Transplantation. 2017 ; Vol. 17, No. 3. pp. 803-808.
@article{406b4b5b25544b85b908b82e4db33e4b,
title = "Acute West Nile Virus Meningoencephalitis Diagnosed Via Metagenomic Deep Sequencing of Cerebrospinal Fluid in a Renal Transplant Patient",
abstract = "Solid organ transplant patients are vulnerable to suffering neurologic complications from a wide array of viral infections and can be sentinels in the population who are first to get serious complications from emerging infections like the recent waves of arboviruses, including West Nile virus, Chikungunya virus, Zika virus, and Dengue virus. The diverse and rapidly changing landscape of possible causes of viral encephalitis poses great challenges for traditional candidate-based infectious disease diagnostics that already fail to identify a causative pathogen in approximately 50{\%} of encephalitis cases. We present the case of a 14-year-old girl on immunosuppression for a renal transplant who presented with acute meningoencephalitis. Traditional diagnostics failed to identify an etiology. RNA extracted from her cerebrospinal fluid was subjected to unbiased metagenomic deep sequencing, enhanced with the use of a Cas9-based technique for host depletion. This analysis identified West Nile virus (WNV). Convalescent serum serologies subsequently confirmed WNV seroconversion. These results support a clear clinical role for metagenomic deep sequencing in the setting of suspected viral encephalitis, especially in the context of the high-risk transplant patient population.",
keywords = "basic (laboratory) research/science, clinical research/practice, diagnostic techniques and imaging, genetics, genomics, infection and infectious agents, infectious disease, kidney (allograft) function/dysfunction, kidney transplantation/nephrology, viral: Epstein-Barr Virus (EBV), viral: West Nile, infection and infectious agents",
author = "Wilson, {M. R.} and Lara Zimmermann and Crawford, {E. D.} and Sample, {H. A.} and Soni, {P. R.} and Baker, {A. N.} and Khan, {L. M.} and DeRisi, {J. L.}",
year = "2017",
month = "3",
day = "1",
doi = "10.1111/ajt.14058",
language = "English (US)",
volume = "17",
pages = "803--808",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Acute West Nile Virus Meningoencephalitis Diagnosed Via Metagenomic Deep Sequencing of Cerebrospinal Fluid in a Renal Transplant Patient

AU - Wilson, M. R.

AU - Zimmermann, Lara

AU - Crawford, E. D.

AU - Sample, H. A.

AU - Soni, P. R.

AU - Baker, A. N.

AU - Khan, L. M.

AU - DeRisi, J. L.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Solid organ transplant patients are vulnerable to suffering neurologic complications from a wide array of viral infections and can be sentinels in the population who are first to get serious complications from emerging infections like the recent waves of arboviruses, including West Nile virus, Chikungunya virus, Zika virus, and Dengue virus. The diverse and rapidly changing landscape of possible causes of viral encephalitis poses great challenges for traditional candidate-based infectious disease diagnostics that already fail to identify a causative pathogen in approximately 50% of encephalitis cases. We present the case of a 14-year-old girl on immunosuppression for a renal transplant who presented with acute meningoencephalitis. Traditional diagnostics failed to identify an etiology. RNA extracted from her cerebrospinal fluid was subjected to unbiased metagenomic deep sequencing, enhanced with the use of a Cas9-based technique for host depletion. This analysis identified West Nile virus (WNV). Convalescent serum serologies subsequently confirmed WNV seroconversion. These results support a clear clinical role for metagenomic deep sequencing in the setting of suspected viral encephalitis, especially in the context of the high-risk transplant patient population.

AB - Solid organ transplant patients are vulnerable to suffering neurologic complications from a wide array of viral infections and can be sentinels in the population who are first to get serious complications from emerging infections like the recent waves of arboviruses, including West Nile virus, Chikungunya virus, Zika virus, and Dengue virus. The diverse and rapidly changing landscape of possible causes of viral encephalitis poses great challenges for traditional candidate-based infectious disease diagnostics that already fail to identify a causative pathogen in approximately 50% of encephalitis cases. We present the case of a 14-year-old girl on immunosuppression for a renal transplant who presented with acute meningoencephalitis. Traditional diagnostics failed to identify an etiology. RNA extracted from her cerebrospinal fluid was subjected to unbiased metagenomic deep sequencing, enhanced with the use of a Cas9-based technique for host depletion. This analysis identified West Nile virus (WNV). Convalescent serum serologies subsequently confirmed WNV seroconversion. These results support a clear clinical role for metagenomic deep sequencing in the setting of suspected viral encephalitis, especially in the context of the high-risk transplant patient population.

KW - basic (laboratory) research/science

KW - clinical research/practice

KW - diagnostic techniques and imaging

KW - genetics

KW - genomics

KW - infection and infectious agents

KW - infectious disease

KW - kidney (allograft) function/dysfunction

KW - kidney transplantation/nephrology

KW - viral: Epstein-Barr Virus (EBV)

KW - viral: West Nile, infection and infectious agents

UR - http://www.scopus.com/inward/record.url?scp=84992418603&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84992418603&partnerID=8YFLogxK

U2 - 10.1111/ajt.14058

DO - 10.1111/ajt.14058

M3 - Article

C2 - 27647685

AN - SCOPUS:84992418603

VL - 17

SP - 803

EP - 808

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

IS - 3

ER -