Diagnosis of Two Meningitis Cases Caused by Rickettsia Felis in China, with Metagenomic Next-Generation Sequencing: A Case Report

Figures & data

Figure 1 The key slices of the spinal cord MRI images of the case 1. (a) Cervical magnetic resonance imaging; (b)Thoracic magnetic resonance imaging.

Table 1 Clinical Laboratory Investigations of Two Patients with R. Felis Infection

Parameter	Case1				Case2
Blood immunity-related tests
	In hospital		At follow-ups 2 months		In hospital		At follow-ups 2 months
ESR	+		-		+		-
PO	+		-		-		-
RNP	+		-		-		-
P-ANCA	+		-		-		-
ANA	+		+		-		-
ACA-IgM	-		-		+		-
CCP	-		-		+		-
Cerebrospinal fluid
	October 27	October 31	November4	November14*	September 29	September 30	October10*	October 17
Intracranial pressure (cm H2O)	41.5	15	22	20	29	35	33	25
Total cell count (cells/mm^3)	260	87	48	6	46	76	46	Not detected
Mononuclear cell proportion (%)	Not detected	16	96	13	Not detected	96	91	Not detected
Polymorphonuclear cell proportion (%)	Not detected	84	4	Not detected	Not detected	4	Not detected	Not detected
Lymphocyte proportion (%)	Not detected	Not detected	Not detected	87	Not detected	Not detected	8	Not detected
Neutrophil proportion (%)	Not detected	Not detected	Not detected	0	Not detected	Not detected	1	Not detected
Glucose (mmol/L)	1.5	2.44	2.99	3.32	3.85	3.31	3.1	Not detected
Chlorine (mmol/L)	116.5	123	125	130.2	126.1	126.1	125.3	Not detected
Protein (g/L)	1.513	0.37	0.46	0.52	0.43	0.56	0.45	Not detected

Notes: *Because the two patients had traveled from hospital to hospital, the CSF cells were not classified in the same way. Before the patient was admitted to our hospital, CSF leukocytes were only divided into mononuclear cells and multinuclear cells. After admission to our hospital, CSF leukocyte classification was more detailed (Case 1: On November 14, Case 2: On October 10).

Figure 2 Results of mNGS in cerebrospinal fluid. (a) Sequencing of R. felis yielded a total coverage of 0.1751%. (b) Sequencing of R. felis yielded a total coverage of 0.0698%.