Acute West Nile virus meningoencephalitis diagnosed via metagenomic deep sequencing of cerebrospinal fluid in a renal transplant patient
Michael R. Wilson, M.D., Lara L. Zimmermann, M.D., Emily D. Crawford, Ph.D., Hannah A. Sample, B.S., Priya Soni, M.D., Amira Baker, M.D., Lillian M. Khan, B.S., Joseph L. DeRisi, Ph.D.American Journal of Transplantation, 2016Abstract:
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 MDS in the setting of suspected viral encephalitis, especially in
the context of the high risk transplant patient population.