Hepatitis B virus in cerebrospinal fluid of a patient with purulent bacterial meningitis detected by multiplex-PCR: A case report

Abstract

BACKGROUND

Bacterial meningitis (BM) is a common central nervous system inflammatory disease. BM may cause serious complications, and early diagnosis is essential to improve the prognosis of affected patients.

CASE SUMMARY

A 37-year-old man was hospitalized with purulent meningitis because of worsening headache for 12 h, accompanied by vomiting, fever, and rhinorrhea. Head computed tomography showed a lesion in the left frontal lobe. Infectious disease screening showed positivity for hepatitis B surface antigen, hepatitis B e antigen, and hepatitis B core antigen. Cerebrospinal fluid (CSF) leak was suspected based on clinical history. Streptococcus pneumoniae (S. pneumoniae) was detected in CSF by metagenomic next-generation sequencing (mNGS) technology, confirming the diagnosis of purulent BM. After treatment, multiplex PCR indicated the presence of hepatitis B virus (HBV) DNA and absence of S. pneumoniae DNA in CSF samples.

CONCLUSION

We report a rare case of HBV in the CSF of a patient with purulent BM. Multiplex PCR is more sensitive than mNGS for detecting HBV DNA.

Keywords: Purulent meningitis; Streptococcus pneumoniae; Hepatitis B virus; Multiplex PCR; Cerebrospinal fluid; Case report

Core Tip: The advantages of multiplex PCR are rapid detection and high sensitivity and accuracy. Multiplex PCR can assist in the diagnosis of bacterial and viral meningitis in culture-negative cerebrospinal fluid (CSF). Furthermore, this technique can improve the accuracy of diagnosis of acute bacterial meningitis (BM) in the clinical setting in culture-positive or culture-negative CSF. We report a rare case of hepatitis B virus (HBV) in the CSF of a patient with purulent BM and demonstrate that multiplex PCR is more sensitive than metagenomic next-generation sequencing for detecting HBV DNA.