Assessing viral metagenomics for the diagnosis of acute undifferentiated fever in returned travellers : a multicenter cohort study
© International Society of Travel Medicine 2024. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissionsoup.com..
BACKGROUND: Up to 45% of febrile returning travellers remain undiagnosed after a thorough diagnostic work-up, even at referral centres. Although metagenomic next-generation sequencing (mNGS) has emerged as a promising tool, evidence of its usefulness in imported fever is very limited.
METHODS: Travellers returning with fever were prospectively recruited in three referral clinics from November 2017 to November 2019. Unbiased mNGS optimised for virus detection was performed on serum samples of participants with acute undifferentiated febrile illness (AUFI), and results were compared to those obtained by reference diagnostic methods (RDM).
RESULTS: Among 507 returned febrile travellers, 433(85.4%) presented with AUFI. Dengue virus (n = 86) and Plasmodium spp. (n = 83) were the most common causes of fever. 103/433(23.8%) AUFI remained undiagnosed at the end of the follow-up.Metagenomic next-generation sequencing unveiled potentially pathogenic microorganisms in 196/433(38.7%) AUFI. mNGS identifications were more common in patients with a shorter duration of fever (42.3% in ≤5 days vs 28.7% in >5 days, P = 0.005). Potential causes of fever were revealed in 25/103(24.2%) undiagnosed AUFI and 5/23(21.7%) travellers with severe undiagnosed AUFI. Missed severe aetiologies included eight bacterial identifications and one co-infection of B19 parvovirus and Aspergillus spp.Additional identifications indicating possible co-infections occurred in 29/316(9.2%) travellers with AUFI, and in 11/128(8.6%) travellers with severe AUFI, who had received a diagnosis through RDM. The most common co-infections detected in severe AUFI were caused by Gram-negative bacteria. Serum mNGS was unable to detect >50% of infectious diagnoses achieved by RDM and also yielded 607 non-pathogenic identifications.
DISCUSSION: mNGS of serum can be a valuable diagnostic tool for selected travellers with undiagnosed AUFI or severe disease in addition to reference diagnostic techniques, especially during the first days of symptoms. Nevertheless, mNGS results interpretation presents a great challenge. Further studies evaluating the performance of mNGS using different sample types and protocols tailored to non-viral agents are needed.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:31 |
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| Enthalten in: |
Journal of travel medicine - 31(2024), 3 vom: 06. Apr. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Camprubí-Ferrer, Daniel [VerfasserIn] |
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| Links: |
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| Themen: |
Dengue |
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| Anmerkungen: |
Date Completed 08.04.2024 Date Revised 25.04.2024 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/jtm/taae029 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM368716341 |
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| 100 | 1 | |a Camprubí-Ferrer, Daniel |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Assessing viral metagenomics for the diagnosis of acute undifferentiated fever in returned travellers |b a multicenter cohort study |
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| 500 | |a Date Revised 25.04.2024 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © International Society of Travel Medicine 2024. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissionsoup.com. | ||
| 520 | |a BACKGROUND: Up to 45% of febrile returning travellers remain undiagnosed after a thorough diagnostic work-up, even at referral centres. Although metagenomic next-generation sequencing (mNGS) has emerged as a promising tool, evidence of its usefulness in imported fever is very limited | ||
| 520 | |a METHODS: Travellers returning with fever were prospectively recruited in three referral clinics from November 2017 to November 2019. Unbiased mNGS optimised for virus detection was performed on serum samples of participants with acute undifferentiated febrile illness (AUFI), and results were compared to those obtained by reference diagnostic methods (RDM) | ||
| 520 | |a RESULTS: Among 507 returned febrile travellers, 433(85.4%) presented with AUFI. Dengue virus (n = 86) and Plasmodium spp. (n = 83) were the most common causes of fever. 103/433(23.8%) AUFI remained undiagnosed at the end of the follow-up.Metagenomic next-generation sequencing unveiled potentially pathogenic microorganisms in 196/433(38.7%) AUFI. mNGS identifications were more common in patients with a shorter duration of fever (42.3% in ≤5 days vs 28.7% in >5 days, P = 0.005). Potential causes of fever were revealed in 25/103(24.2%) undiagnosed AUFI and 5/23(21.7%) travellers with severe undiagnosed AUFI. Missed severe aetiologies included eight bacterial identifications and one co-infection of B19 parvovirus and Aspergillus spp.Additional identifications indicating possible co-infections occurred in 29/316(9.2%) travellers with AUFI, and in 11/128(8.6%) travellers with severe AUFI, who had received a diagnosis through RDM. The most common co-infections detected in severe AUFI were caused by Gram-negative bacteria. Serum mNGS was unable to detect >50% of infectious diagnoses achieved by RDM and also yielded 607 non-pathogenic identifications | ||
| 520 | |a DISCUSSION: mNGS of serum can be a valuable diagnostic tool for selected travellers with undiagnosed AUFI or severe disease in addition to reference diagnostic techniques, especially during the first days of symptoms. Nevertheless, mNGS results interpretation presents a great challenge. Further studies evaluating the performance of mNGS using different sample types and protocols tailored to non-viral agents are needed | ||
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a dengue | |
| 650 | 4 | |a malaria | |
| 650 | 4 | |a metagenomic next-generation sequencing | |
| 650 | 4 | |a travel-related febrile illness | |
| 700 | 1 | |a Tomazatos, Alexandru |e verfasserin |4 aut | |
| 700 | 1 | |a Balerdi-Sarasola, Leire |e verfasserin |4 aut | |
| 700 | 1 | |a Cobuccio, Ludovico G |e verfasserin |4 aut | |
| 700 | 1 | |a Van Den Broucke, Steven |e verfasserin |4 aut | |
| 700 | 1 | |a Horváth, Balázs |e verfasserin |4 aut | |
| 700 | 1 | |a Van Esbroeck, Marjan |e verfasserin |4 aut | |
| 700 | 1 | |a Martinez, Miguel J |e verfasserin |4 aut | |
| 700 | 1 | |a Gandasegui, Javier |e verfasserin |4 aut | |
| 700 | 1 | |a Subirà, Carme |e verfasserin |4 aut | |
| 700 | 1 | |a Saloni, Meritxell |e verfasserin |4 aut | |
| 700 | 1 | |a Genton, Blaise |e verfasserin |4 aut | |
| 700 | 1 | |a Bottieau, Emmanuel |e verfasserin |4 aut | |
| 700 | 1 | |a Cadar, Dániel |e verfasserin |4 aut | |
| 700 | 1 | |a Muñoz, Jose |e verfasserin |4 aut | |
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