Metagenomic locus typing identifies a likely point source exposure for a fungal meningitis outbreak caused by Fusarium solani

Metagenomic next-generation sequencing (mNGS) was used to investigate an outbreak of suspected fungal meningitis in US patients undergoing surgical procedures under spinal anesthesia in Matamoros, Mexico. Fragments of fungal DNA from the Fusarium solani species complex were detected in cerebrospinal fluid, plasma, and/or brain biopsy samples from 4 patients from 3 states, 2 of whom died from the infection. Using a novel analytic method called metaMELT (metagenomic multiple extended locus typing), we mapped randomly distributed fungal DNA reads from each patient to their corresponding locations on existing and newly sequenced Fusarium solani reference genomes