Microscopic view of the brain with interconnected neurons, tapeworm structures, and genetic sequencing data.

Mystery Solved: How Cutting-Edge Tech Finally Unmasked a Rare Meningitis Culprit

Lena Kashyap in Health & Wellness June 2025 • 4 min read.

"For 15 years, she battled chronic relapsing meningitis. Standard tests failed, but a revolutionary approach revealed the answer hidden in plain sight."

Imagine living with a condition that doctors can't quite figure out. For a woman in her early 40s, this was her reality. For 15 long years, she experienced recurring bouts of meningitis, a serious inflammation of the membranes surrounding the brain and spinal cord. Each episode brought fever, stiff neck, and agonizing pain. Doctors ran test after test, but the cause remained elusive.

Meningitis can stem from various sources, including bacteria, viruses, and fungi. Sometimes, the culprit is an autoimmune disorder, where the body mistakenly attacks its own tissues. In this woman's case, initial suspicions leaned toward tuberculosis (TB) meningitis, a particularly dangerous form of the disease. She underwent treatment, but her symptoms continued to flare up intermittently.

The cycle of hope and disappointment continued. The woman underwent countless investigations, endured multiple treatments, and even had a biopsy. Still, the true cause of her suffering remained hidden, impacting her quality of life and leaving medical experts baffled. Frustrated, doctors turned to research, with UCSF to investigate her CSF with metagenomic next-generation sequencing (mNGS).

Metagenomic Next-Generation Sequencing (mNGS): A High-Tech Detective

Microscopic view of the brain with interconnected neurons, tapeworm structures, and genetic sequencing data.

Traditional diagnostic methods can sometimes fall short, especially when dealing with unusual or persistent infections. That's where metagenomic next-generation sequencing (mNGS) comes in. Think of it as a super-powered detective tool that can sift through a sample and identify virtually any organism present, whether it's a virus, bacterium, fungus, or parasite. It works by analyzing all the genetic material in a sample, providing a comprehensive snapshot of the microbial landscape.

In this particular case, doctors extracted RNA from the patient's cerebrospinal fluid (CSF) and analyzed complementary DNA (cDNA), followed by using bioinformatics pipeline to remove human, low complexity, redundant, and poor quality sequences. The remaining sequences are searched against all known organisms. The process works by creating a genetic library and comparing it to a vast database of known organisms. If there's a match, the previously hidden culprit is revealed.

Unbiased Approach: mNGS doesn't rely on pre-existing assumptions, making it ideal for uncovering unexpected causes.
Comprehensive Detection: It can identify a wide range of infectious agents in a single test.
Growing Momentum: mNGS is increasingly used in challenging cases where standard tests fail.

The results were stunning. The analysis revealed the presence of Taenia solium, also known as the pork tapeworm. This parasite causes a condition called neurocysticercosis (NCC), where cysts form in the brain and spinal cord. Suddenly, years of uncertainty were replaced with a concrete diagnosis.

A New Path Forward: Treatment and Recovery

Armed with the correct diagnosis, doctors started the woman on a combination of anti-helminthic drugs to eliminate the parasite, along with a TNF-alpha inhibitor. The treatment proved successful. For the first time in years, she was able to reduce her steroid dosage and eventually discontinue them altogether. Scans showed improvement, and her cerebrospinal fluid returned to a more normal state. While she still experiences some fatigue and pain, she's finally on the road to recovery.

About this Article -

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Everything You Need To Know

What is metagenomic next-generation sequencing (mNGS), and why is it so important?

Metagenomic Next-Generation Sequencing (mNGS) is an advanced diagnostic technique used to identify a wide range of organisms, including bacteria, viruses, fungi, and parasites, by analyzing the genetic material in a sample. It works by creating a comprehensive genetic library from the sample and comparing it against a vast database of known organisms. Its significance lies in its ability to detect the cause of infection when standard tests are inconclusive, offering an unbiased and comprehensive approach to identifying infectious agents. The implications are that it can uncover previously hidden pathogens, leading to accurate diagnoses and targeted treatments, especially in complex and persistent cases. It's important because without the use of mNGS, the patient would have continued to suffer without a proper diagnosis.

What is Taenia solium, and why is it important to know about it in cases like this?

Taenia solium, also known as the pork tapeworm, is a parasitic worm that can cause a condition called neurocysticercosis (NCC), where cysts form in the brain and spinal cord. This is important because it highlights a potential cause of chronic meningitis that may be overlooked by standard diagnostic methods. The implications of Taenia solium infection are significant, as it can lead to severe neurological symptoms and chronic suffering if left undiagnosed and untreated. In this instance, the patient had been suffering for 15 years.

What is cerebrospinal fluid (CSF), and why is it important in diagnosing meningitis?

Cerebrospinal fluid (CSF) is the fluid that surrounds the brain and spinal cord, providing cushioning and protection. Analyzing CSF is important in diagnosing conditions affecting the central nervous system, such as meningitis. The implications of CSF analysis are that it can reveal the presence of infectious agents, inflammation, or other abnormalities that help pinpoint the cause of neurological symptoms. It is commonly extracted during a spinal tap to test for a variety of conditions. CSF was the key to unlocking the mystery.

What is neurocysticercosis (NCC), and why should people be aware of its potential impact?

Neurocysticercosis (NCC) is a condition caused by the parasite Taenia solium, where cysts form in the brain and spinal cord. Its importance lies in its ability to cause chronic neurological symptoms, such as seizures, headaches, and meningitis. The implications of NCC are that it can significantly impact a person's quality of life and require long-term treatment with anti-parasitic medications and other supportive therapies. This was the root cause of the patient's suffering.

What are TNF-alpha inhibitors, and why were they used in this treatment?

TNF-alpha inhibitors are medications that block the activity of tumor necrosis factor-alpha (TNF-alpha), a protein involved in inflammation. Their importance lies in their ability to reduce inflammation in conditions such as autoimmune disorders and chronic infections. The implications of using TNF-alpha inhibitors are that they can alleviate symptoms and improve outcomes in inflammatory conditions, but they may also increase the risk of infections and other side effects. Using these helped the patient manage the inflammation while tackling the root cause with other medications. They are often used to treat a variety of conditions.