{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T22:20:24Z","timestamp":1791498024849,"version":"4.3.4"},"reference-count":24,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2015,8,24]],"date-time":"2015-08-24T00:00:00Z","timestamp":1440374400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"American Brain Foundation Clinical Research Training Fellowship"},{"DOI":"10.13039\/100000011","name":"Howard Hughes Medical Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000011","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences of the NIH","doi-asserted-by":"crossref","award":["KL2TR000143"],"award-info":[{"award-number":["KL2TR000143"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2015,11]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Identification of a particular cause of meningoencephalitis can be challenging owing to the myriad bacteria, viruses, fungi, and parasites that can produce overlapping clinical phenotypes, frequently delaying diagnosis and therapy. Metagenomic deep sequencing (MDS) approaches to infectious disease diagnostics are known for their ability to identify unusual or novel viruses and thus are well suited for investigating possible etiologies of meningoencephalitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We present the case of a 74\u2010year\u2010old woman with endophthalmitis followed by meningoencephalitis. MDS of her cerebrospinal fluid (CSF) was performed to identify an infectious agent.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sequences aligning to <jats:italic>Balamuthia mandrillaris<\/jats:italic> ribosomal RNA genes were identified in the CSF by MDS. Polymerase chain reaction subsequently confirmed the presence of <jats:italic>B. mandrillaris<\/jats:italic> in CSF, brain tissue, and vitreous fluid from the patient's infected eye. <jats:italic>B. mandrillaris<\/jats:italic> serology and immunohistochemistry for free\u2010living amoebas on the brain biopsy tissue were positive.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>The diagnosis was made using MDS after the patient had been hospitalized for several weeks and subjected to costly and invasive testing. MDS is a powerful diagnostic tool with the potential for rapid and unbiased pathogen identification leading to early therapeutic targeting. Ann Neurol 2015;78:Ann Neurol 2015;78:679\u2013696<\/jats:p><\/jats:sec>","DOI":"10.1002\/ana.24499","type":"journal-article","created":{"date-parts":[[2015,8,20]],"date-time":"2015-08-20T08:21:48Z","timestamp":1440058908000},"page":"722-730","source":"Crossref","is-referenced-by-count":124,"title":["Diagnosing <scp><i>Balamuthia mandrillaris<\/i><\/scp><scp>E<\/scp>ncephalitis <scp>W<\/scp>ith <scp>M<\/scp>etagenomic <scp>D<\/scp>eep<scp> S<\/scp>equencing"],"prefix":"10.1002","volume":"78","author":[{"given":"Michael R.","family":"Wilson","sequence":"first","affiliation":[{"name":"Department of Biochemistry and Biophysics University of California San Francisco CA"},{"name":"Department of Neurology University of California San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niraj M.","family":"Shanbhag","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Reid","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Infectious Diseases University of California San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neel S.","family":"Singhal","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey M.","family":"Gelfand","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah A.","family":"Sample","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barlas","family":"Benkli","sequence":"additional","affiliation":[{"name":"Koc University Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian D.","family":"O'Donovan","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Biophysics University of California San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibne K.M.","family":"Ali","sequence":"additional","affiliation":[{"name":"Free\u2010Living and Intestinal Amebas Laboratory, Centers for Disease Control and Prevention Atlanta GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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