Clinical performance of metagenomic next-generation sequencing in the diagnosis of Epstein-Barr virus central nervous system infections.

Metagenomic next-generation sequencing (mNGS) has been widely utilized for diagnosing infectious diseases. However, studies employing mNGS to detect EBV central nervous system (CNS) infections remain scarce. Therefore, this study aimed to evaluate the diagnostic performance of mNGS in EBV CNS infections. Patients discharged with the diagnosis of CNS viral infection and underwent lumbar puncture for mNGS of cerebrospinal fluid between January 2021 and May 2024 were selected. The selected cerebrospinal fluid samples were subjected to PCR, including those that were EBV-negative in mNGS. Clinical data were collected for analysis. A total of 96 samples were included: 18 samples in the EBV infection group (PCR EBV DNA +), 30 samples in the suspected EBV infection group (PCR EBV DNA - but mNGS +), and 48 samples in the non-EBV-infected group (PCR EBV DNA - and mNGS -). All PCR-positive samples were also positive by mNGS, and in the EBV infection group, the viral load detected by PCR was strongly correlated with the number of sequences identified by mNGS (ρ = 0.752, p = 0.00). The number of sequences in the EBV infection group was higher than that in the suspected EBV infection group (14 vs. 4, p = 0.04). Patients in the EBV high sequence group experienced fewer headaches, nausea, and vomiting, had less elevated intracranial pressure, but required longer hospitalization (p = 0.003, 0.005, 0.03, and 0.03, respectively). The mNGS method is a sensitive tool for detecting EBV CNS infections.