Construction of a "three-stage and four-level" evaluation system for cerebrospinal fluid pathogens based on mNGS: insights from a case of co-detection of Cryptococcus and Epstein-barr virus.

BACKGROUND

Metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) has brought about a revolutionary change in the diagnosis of central nervous system (CNS) infections. Nevertheless, the interpretation of results with multiple detected pathogens still poses a substantial clinical challenge.

AIM: A preliminary exploration of the application value of the developed "Three-Stage, Four-Level" assessment system in interpreting mNGS cerebrospinal fluid test reports.

METHODS

Based on a systematic review of relevant domestic and international literature, combined with practical experience in the field, a multi-dimensional "Three-Stage, Four-Level" evaluation system centered on a clinical-microbiological evidence chain was constructed. This study explores the application value of the system through a case of mNGS detection for co-preservation of Cryptococcus and Epstein-Barr virus (EBV) in cerebrospinal fluid (CSF).

RESULTS

The system effectively integrated multi-source information, facilitating a precise and stratified interpretation of CSF mNGS results. It successfully differentiated Cryptococcus as the pathogenic agent and EBV as a latent pathogen. Consequently, early antifungal therapy was initiated, resulting in a gradual improvement of symptoms and a favorable prognosis.

CONCLUSION

This case initially demonstrates that the "Three-Stage,Four-Level "evaluation system provides a standardized and operational framework for interpreting mNGS cerebrospinal fluid multiplex pathogen detection results, showing preliminary value in precisely distinguishing pathogen types; however, further validation with larger sample sizes is warranted.