Rare Case of Community-Acquired Endocarditis Caused by Neisseria meningitidis Assessed by Clinical Metagenomics

Article Article scientifique Rapport de cas Rare Case of Community-Acquired Endocarditis Caused by Neisseria meningitidis Assessed by Clinical Metagenomics eng 2019 author Choutko Vassili 596348 author Lazarevic Vladimir 0000-0002-6839-2536 684594 author Gaia Nadia 800637 author Girard Myriam 666631 author Renzi Gesuele 111073 author Leo Stefano 876581 author Keller Peter M author Huber Christoph 0000-0001-9048-849X 853395 author Schrenzel Jacques 29184 112 10.3389/fcvm.2019.00112 31448292 2297-055X https://www.frontiersin.org/articles/10.3389/fcvm.2019.00112/full The most common causes of infective endocarditis (IE) are Staphylococcus, Streptococcus, Enterococcus, and HACEK-related organisms. In 15-30% of the IE cases, standard blood cultures remain sterile. We aimed at identifying the causative agent of a blood-culture-negative IE by whole metagenome shotgun sequencing (WMGS). A 54-year old woman diagnosed with community-onset pneumonia by a general practitioner, was admitted with dyspnea, cough and fever. The patient's blood cultures were repeatedly negative. The transesophageal echocardiography and transthoracic echocardiography showed an echo density on the left coronary leaflet of the aortic valve and signs suggestive of a ruptured abscess of the mitro-aortic junction. The patient underwent a semi-urgent aortic valve replacement by a mechanical prosthetic valve. We extracted DNA from the surgically-removed fresh valve tissue. The extraction procedure included bacterial/fungal DNA enrichment procedure. Nextera XT library prepared from the valve DNA extract was sequenced (2 × 250) on an Illumina MiSeq instrument. Sequence reads were mapped against bacterial genomic sequences, 16S rRNA genes and clade-specific taxonomic markers. Most of the 103,136 sequencing reads classified as bacterial were assigned to Neisseria meningitidis. In line with these data, mapping of reads against clade-specific and 16S rRNA gene markers revealed N. meningitidis as the most represented species. Assembled metagenomic fragments had the best average nucleotide identity (ANI) with N. meningitidis. Comparison of assembled contigs to reference alleles showed that this strain belongs to the ST-41/44 complex. N. meningitidis is commonly associated with meningitis and/or septicemia but should not be neglected as a causative agent of IE, which became exceedingly rare with the introduction of antibiotics. Our data show that WMGS may be used as a diagnostic procedure to strengthen the diagnosis of IE and to obtain draft genomic sequence of the pathogen and typing information. Next-generation sequencing Cardiac valve Endocarditis Culture-negative infection Clinical Metagenomics Neisseria meningitidis Dewey 616 Dewey 617 56 Département de médecine 221 57 Département de chirurgie 222 false 338 Génomique et microbiote 604 1290 Recherche cardiovasculaire et de propulsion hémodynamique 1009 https://www.ebi.ac.uk/ena/data/view/PRJEB24753 Frontiers in Cardiovascular Medicine 6 cac86857-b37f-4c61-aa0a-06a1a55b84a6 Article (Published version) Public fcvm-06-00112.pdf 851128 application/pdf CC BY bb4dd005-c104-40de-ac72-b1359a9e5f6d Supplemental data Public Data_Sheet_1.pdf 130374 application/pdf CC BY openAccess Faculté de médecine / Section de médecine clinique / Département de médecine Faculté de médecine / Section de médecine clinique / Département de chirurgie

Title	Published in	Year	Views	Downloads

Rare Case of Community-Acquired Endocarditis Caused by Neisseria meningitidis Assessed by Clinical Metagenomics	Frontiers in Cardiovascular Medicine	2019	369	187
An uncommon cause of hypoxemia: platypnea-orthodeoxia syndrome	Journal of Geriatric Cardiology	2015	418	71

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Choutko, Vassili