Metagenomic Next-Generation Sequencing Direct Diagnosis of Mixed Bacterial Meningitis in a Child: A Case Report

Wei Wang,* Yujuan Wang,* Xiaowei Xin, Yi Yin, Chun Zhao, Youpeng Jin Department of Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, 250021, People’s Republic of China*These authors contributed equally to this workCorrespondence: Youpeng Jin, Department of Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwu Road, Huaiyin District, Jinan, 250021, Shandong Province, People’s Republic of China, Tel +86 15168863809, Email [email protected]: Bacterial meningitis is a major cause of mortality and morbidity in children worldwide. Meanwhile, mixed bacterial meningitis is a rare entity. However, it is difficult to identify anaerobic pathogens using traditional culture methods. Disorders such as neurosurgical interventions are considered risk factors for the development of such cerebral infection. Early diagnosis and appropriate therapy may contribute to patient survival.Case Presentation: We report the use of metagenomic next-generation sequencing (mNGS) to facilitate the diagnosis and treatment of polymicrobial meningitis in a 35-month-old male child with a history of detethering procedure for tethered cord syndrome (TCS). The mNGS tests identified six bacterial species from CSF specimens, including four ones of anaerobic bacteria. The subsequent examination of magnetic resonance imaging (MRI) revealed abnormal imaging findings of the lumbosacral area. The patient eventually recovered from severe infections due to long-term antibiotic treatment and radical surgery.Conclusion: This case demonstrates the advantages of mNGS for the rapid and accurate diagnosis of mixed bacterial meningitis, highlighting its application of identifying uncommon pathogens in severe infections. For patients who suffered from exacerbated brain infection with history of detethering surgery, anaerobic cultivation is needed and empiric antibiotic therapy should consider mixed infection in these situations.Keywords: meningitis, metagenomic next-generation sequencing, children, case report