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.
authors.affiliation: Department of Biochemistry and Biophysics, University of California, San Francisco, CA.|Howard Hughes Medical Institute, Chevy Chase, MD.
authors.forename: M R
authors.initials: MR
authors.lastname: Wilson
authors.affiliation: Department of Neurosurgery, University of California, Los Angeles, CA.
authors.forename: L L
authors.initials: LL
authors.lastname: Zimmermann
authors.affiliation: Department of Biochemistry and Biophysics, University of California, San Francisco, CA.|Department of Neurology, University of California, San Francisco, CA.
authors.forename: E D
authors.initials: ED
authors.lastname: Crawford
authors.affiliation: Department of Biochemistry and Biophysics, University of California, San Francisco, CA.|Howard Hughes Medical Institute, Chevy Chase, MD.
authors.forename: H A
authors.initials: HA
authors.lastname: Sample
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, University of California, Los Angeles, CA.
authors.forename: P R
authors.initials: PR
authors.lastname: Soni
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, University of California, Los Angeles, CA.
authors.forename: A N
authors.initials: AN
authors.lastname: Baker
authors.affiliation: Department of Biochemistry and Biophysics, University of California, San Francisco, CA.
authors.forename: L M
authors.initials: LM
authors.lastname: Khan
authors.affiliation: Department of Biochemistry and Biophysics, University of California, San Francisco, CA.|Department of Neurology, University of California, San Francisco, CA.
authors.forename: J L
authors.initials: JL
authors.lastname: DeRisi
mesh_terms: D000293:Adolescent; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology; D006085:Graft Survival; D059014:High-Throughput Nucleotide Sequencing / Q000379:methods*; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008590:Meningoencephalitis / Q000175:diagnosis* / Q000821:virology; D056186:Metagenomics; D011379:Prognosis; D012307:Risk Factors; D014901:West Nile Fever / Q000175:diagnosis* / Q000821:virology; D014902:West Nile virus / Q000235:genetics* / Q000472:pathogenicity
chemical_list: D007166:Immunosuppressive Agents
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