Clinical Consistency Analysis Of Cerebrospinal Fluid Next-Generation Sequencing For Diagnosis Of Virus Encephalitis

Objective: To explore the clinical value of cerebrospinal fluid next-generation sequencing technology in diagnosis of virus encephalitis.Methods:Retrospectively collection of clinical data of 44 patients with viral sequences detected by next-generation sequencing of cerebrospinal fluid was performed in the Second Hospital of Hebei Medical University from August 2017 to May 2019.The relevant data included basic information,current medical history,past history,time of submission,laboratory examination,imaging examination,lumbar puncture results,treatment plan,outcome,etc,which were used to analyze the consistency of CSF second-generation sequencing technology and clinical diagnosis in central nervous system virus infection.Results:From August 2017 to May 2019,a total of 44 patients were detected by cerebrospinal fluid next-generation sequencing in the second hospital of hebei medical university,of which 29 were males and 15 were females.The ratio of male to female was 1.93:1,ranging in age from 15 to 85 years old,with a median age of 46 years old.The virus types detected in 44 cases were mainly human herpesviruses and the top five viruses in order were: EB virus,varicella-zoster virus,human a herpesvirus type 1,cytomegalovirus,and human herpesvirus 6A.Among the 44 patients,18 were in the diagnosis consistent group,and the consistency between CSF second-generation sequencing technology and clinical diagnosis was 40.9%.The clinical manifestations of the 18 patients were varied,but the main symptoms were cerebral hemisphere involvement and meningeal stimulation,which were headache in 12 cases(66.7%),fever in 12 cases(66.7%),unconsciousness in 2 cases(11.1%),dizziness in 3 cases(16.7%),nausea and vomiting in 2 cases(11.1%),and seizures in 1 case(5.5%).There were also 4 cases(22.2%)of mental symptoms,including 2 cases of gibberish and 2 cases of irritability.It can also show symptoms of cerebellar involvement,such as 1 case of unstable walking(5.5%).Of the 26 patients in the diagnosis-inconsistency group,10 were finally diagnosed with Tuberculous meningitis,4 were Cryptococcal meningitis,2 were Autoimmune encephalitis,3 were Bacterial meningitis,1 were NMOSD,1 were Neurobrucellosis,1 were Neuronal intranuclear inclusion disease,1 were Cerebral infarction,1 were epilepsy,and 1 were peripheral neuropathy.Conclusion:1.Viral encephalitis is more common in middle-aged people,with more males than females.The main clinical manifestations are cerebral hemisphere involvement and meningeal stimulation symptoms.Headaches and fever are the main manifestations.2.Traditional diagnostic methods such as lumbar puncture,CSF cytology and PCR are still playing an important role in the diagnosis of viral encephalitis.3.CSF second-generation sequencing has the advantages of assisting clinical identification of pathogens,discovering new pathogens and obtaining more pathogen information.4.The sensitivity and specificity of CSF second-generation sequencing may still need to be further improved,and the interpretation of the report needs to be further optimized.5.The higher the number of specific sequences,the higher the confidence.If necessary,PCR and Sanger sequencing can be used for further verification.