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Case Report: Confirmation by Metagenomic Sequencing of Visceral Leishmaniasis in an Immunosuppressed Returned Traveler

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  • 1 Department of Infectious Diseases, Austin Health, Heidelberg, Australia;
  • | 2 Department of Microbiology, Austin Health, Heidelberg, Australia;
  • | 3 Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, Peter Doherty Institute for Infection and Immunity, Parkville, Australia;
  • | 4 The Florey Institute of Neuroscience and Mental Health, Parkville, Australia;
  • | 5 Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, Australia;
  • | 6 Department of Neurology, Royal Melbourne Hospital, Parkville, Australia;
  • | 7 Department of Clinical Haematology, Austin Health, Heidelberg, Australia

ABSTRACT

There has been increased interest in using metagenomic next-generation sequencing as an unbiased approach for diagnosing infectious diseases. We describe a 61-year-old man on fingolimod therapy for multiple sclerosis with an extensive travel history who presented with 7 months of fevers, night sweats, and weight loss. Peripheral blood tests showed pancytopenia and abnormal acute phase reactants. A bone marrow aspirate showed the presence of numerous intracellular and extracellular amastigotes consistent with visceral leishmaniasis (VL). Metagenomic sequencing of the bone marrow aspirate confirmed Leishmania infantum, a species widely reported in the Mediterranean region. This correlated with acquisition of VL infection during the patient’s most recent epidemiological exposure in southern Italy 12 months prior. This case demonstrates the potential application of metagenomic sequencing for identification and speciation of Leishmania in cases of VL; however, further assessment is required using other more readily obtained clinical samples such as blood.

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Author Notes

Address correspondence to Eloise Williams, Department of Microbiology and Infectious Diseases, Austin Health, 145 Studley Rd., Heidelberg 3084, Australia. E-mail: eloise.williams@austin.org.au

Disclosure: Ethics approval for metagenomic sequencing of human clinical samples was obtained through the Austin Health Human Research Ethics Committee (approval no. HREC/15/Austin/396), and informed consent was obtained from the patient as part of this protocol. Metagenomic sequence data from this study are available through the European Nucleotide Archive (BioProject PRJEBXXXXX).

Financial support: This work was supported by grants from the Austin Medical Research Foundation and the CASS Foundation (reference no. 7113). J. C. K. (GNT1142613 and Centre for Research Excellence in Emerging Infectious Diseases GNT1102962) and B. P. H. (GNT1105905) are supported by the National Health and Medical Research Council of Australia.

Authors’ addresses: Eloise Williams and Marcel Leroi, Department of Infectious Diseases, Austin Health, Heidelberg, Australia, and Department of Microbiology, Austin Health, Heidelberg, Australia, E-mails: eloise.williams@austin.org.au and marcel.leroi@austin.org.au. Nicole S. Isles and Torsten Seemann, Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, Peter Doherty Institute for Infection and Immunity, Parkville, Australia, E-mails: isles.n@unimelb.edu.au and t.seemann@unimelb.edu.au. Trevor Kilpatrick, The Florey Institute of Neuroscience and Mental Health, Parkville, Australia, Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, Australia, and Department of Neurology, Royal Melbourne Hospital, Parkville, Australia, E-mail: tkilpat@florey.edu.au. Andrew Grigg, Department of Clinical Haematology, Austin Health, Heidelberg, Australia, E-mail: andrew.grigg@austin.org.au. Benjamin P. Howden and Jason C. Kwong, Department of Infectious Diseases, Austin Health, Heidelberg, Australia, and Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, Peter Doherty Institute for Infection and Immunity, Parkville, Australia, E-mails: bhowden@unimelb.edu.au and jason.kwong@austin.org.au.

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