Gao DQ, Hu YQ, Wang X, Zhang YZ. Hepatitis B virus in cerebrospinal fluid of a patient with purulent bacterial meningitis detected by multiplex-PCR: A case report. World J Clin Cases 2022; 10(5): 1697-1701 [PMID: 35211611 DOI: 10.12998/wjcc.v10.i5.1697]
Corresponding Author of This Article
Yun-Zhou Zhang, PhD, Chief Physician, Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China. bjyuz657@163.com
Research Domain of This Article
Infectious Diseases
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dai-Quan Gao, Yun-Zhou Zhang, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Yong-Qiang Hu, Department of Critical Care Medicine, Beijing Fengtai You'anmen Hospital, Beijing 100069, China
Xin Wang, Department of Intensive Medicine, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
Author contributions: Gao DQ and Zhang YZ were the patient’s neurosurgeons, reviewed the literature, contributed to manuscript drafting, and were responsible for the revision of the manuscript for important intellectual content; Hu YQ and Wang X reviewed the literature, and analyzed and interpreted the imaging findings; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yun-Zhou Zhang, PhD, Chief Physician, Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China. bjyuz657@163.com
Received: September 8, 2021 Peer-review started: September 8, 2021 First decision: October 27, 2021 Revised: November 26, 2021 Accepted: January 8, 2022 Article in press: January 8, 2022 Published online: February 16, 2022 Processing time: 156 Days and 3.1 Hours
Abstract
BACKGROUND
Bacterial meningitis (BM) is a common central nervous system inflammatory disease. BM may cause serious complications, and early diagnosis is essential to improve the prognosis of affected patients.
CASE SUMMARY
A 37-year-old man was hospitalized with purulent meningitis because of worsening headache for 12 h, accompanied by vomiting, fever, and rhinorrhea. Head computed tomography showed a lesion in the left frontal lobe. Infectious disease screening showed positivity for hepatitis B surface antigen, hepatitis B e antigen, and hepatitis B core antigen. Cerebrospinal fluid (CSF) leak was suspected based on clinical history. Streptococcus pneumoniae (S. pneumoniae) was detected in CSF by metagenomic next-generation sequencing (mNGS) technology, confirming the diagnosis of purulent BM. After treatment, multiplex PCR indicated the presence of hepatitis B virus (HBV) DNA and absence of S. pneumoniae DNA in CSF samples.
CONCLUSION
We report a rare case of HBV in the CSF of a patient with purulent BM. Multiplex PCR is more sensitive than mNGS for detecting HBV DNA.
Core Tip: The advantages of multiplex PCR are rapid detection and high sensitivity and accuracy. Multiplex PCR can assist in the diagnosis of bacterial and viral meningitis in culture-negative cerebrospinal fluid (CSF). Furthermore, this technique can improve the accuracy of diagnosis of acute bacterial meningitis (BM) in the clinical setting in culture-positive or culture-negative CSF. We report a rare case of hepatitis B virus (HBV) in the CSF of a patient with purulent BM and demonstrate that multiplex PCR is more sensitive than metagenomic next-generation sequencing for detecting HBV DNA.
