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Volume 23, Number 10—October 2017

Dispatch

Diagnosis of Fatal Human Case of St. Louis Encephalitis Virus Infection by Metagenomic Sequencing, California, 2016

Charles Y. ChiuComments to Author , Lark L. Coffey, Jamie Murkey, Kelly Symmes, Hannah A. Sample, Michael R. Wilson, Samia N. Naccache, Shaun Arevalo, Sneha Somasekar, Scot Federman, Doug Stryke, Paul Vespa, Gary Schiller, Sharon Messenger, Romney Humphries, Steve Miller, and Jeffrey D. Klausner
Author affiliations: University of California, San Francisco, California, USA (C.Y. Chiu, H.A. Sample, M.R. Wilson, S. Arevalo, S. Somasekar, S. Miller); University of California, San Francisco–Abbott Viral Diagnostics and Discovery Center, San Francisco (C.Y. Chiu, S. Arevalo, S. Somasekar, S. Miller); University of California, Davis, California, USA (L.L. Coffey, K. Symmes); University of California, Los Angeles, California, USA (J. Murkey, S. Federman, D. Stryke, P. Vespa, G. Schiller, R. Humphries, J.D. Klausner); University of Southern California, Los Angeles (S.N. Naccache); California Department of Public Health, Richmond, California, USA (S. Messenger)

Main Article

Table 2

Results of follow-up confirmatory testing for SLEV after mNGS result for a patient with fatal mosquito-borne St. Louis encephalitis virus infection diagnosed by metagenomic sequencing, California, 2016*

Test (hospital day sample collected)
Laboratory
Result
CSF studies
SLEV, RT-PCR (9) UCSF research lab Positive
SLEV, RT-PCR (3,9) CDPH Positive
SLEV, RT-PCR (3,9) CDC Positive
Viral culture (3,9) CDC Positive, confirmed as SLEV by RT-PCR
SLEV, IgG/IgM antibody (3,9) Quest Diagnostics Negative, <1:10
SLEV, PRNT for neutralizing antibodies (9) CDPH Negative, <1:10
WNV, IgM
WNV, PRNT for neutralizing antibodies (9)
CDPH
Negative, <1:10
Serum studies
SLEV, RT-PCR (23) CDPH Negative
SLEV, IgM antibody (23) CDPH Negative, <1:10
WNV, IgM antibody (23) CDPH Negative, <1:10
SLEV, PRNT for neutralizing antibodies (23) CDPH Negative, <1:10
WNV, PRNT for neutralizing antibodies (23) CDPH Borderline positive, 1:10 (normal <1:10)

*Tests were performed after mNGS testing of patient CSF was positive from aliquots collected on hospital days 3 and 9. CDC, Centers for Disease Control and Prevention; CDPH, California Department of Public Health; CSF, cerebrospinal fluid; mNGS, metagenomic next-generation sequencing; PRNT, plaque-reduction neutralization testing; RT-PCR, reverse transcription PCR; SLEV, St. Louis encephalitis virus; UCSF, University of California, San Francisco; WNV, West Nile virus.

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