Diagnosis of Fulminant Pneumonia Caused by Legionella pneumophila Serogroup 8 with the Sequence Analysis of the 16S rRNA Gene
Diagnosis of Fulminant Pneumonia Caused by Legionella pneumophila Serogroup 8 with the Sequence Analysis of the 16S rRNA Gene
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DOI：
10.1620/tjem.225.65
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发表时间：
2011-09-01
影响因子：
2.2
通讯作者：
Mukae, Hiroshi
中科院分区：
文献类型：
--
作者：
Kawanami, Toshinori;Yatera, Kazuhiro;Mukae, Hiroshi
肺炎是日本第四大死因。准确和快速检测致病病原体对于适当的抗微生物治疗是必要和重要的，特别是对于迅速进展的肺炎患者或免疫功能低下患者。传统的方法，如培养、尿液抗原检测或特定基因的PCR扩增，不可避免地需要对每个病例的潜在病原体进行精确的推定，而由意想不到的微生物引起的肺炎可能导致抗菌治疗不足和不幸的后果。我们在此报告一位免疫功能低下的女性患者（69岁），由军团菌（L.）嗜肺血清8组引起的暴发性肺炎。普通培养方法和尿抗原检测均未能鉴定出病原菌。因此，从支气管肺泡灌洗液中提取DNA，用于基于pcr的细菌16S rRNA基因克隆。分离克隆的测序分析显示嗜肺乳杆菌的优势。根据这些信息，患者接受了适当和成功的抗菌治疗。此外，通过培养支气管肺泡灌洗液鉴定嗜肺乳杆菌血清8组，并用嗜肺乳杆菌抗血清进行血清分型。16S rRNA基因测序分析可以在不对生物体进行任何假设的情况下揭示潜在的病原体，并可以评估每个标本中细菌种类和比例。总之，这种与培养无关的方法是一种潜在的肺炎诊断方法，特别是对于快速进展的肺炎患者或免疫功能低下的患者。
Pneumonia is the fourth leading cause of death in Japan. Accurate and rapid detection of the causative pathogen(s) is necessary and important for appropriate antimicrobial treatment, especially in patients with rapidly progressive pneumonia or immunocompromised patients. Conventional methods, such as cultivations, detection of urinary antigens or PCR amplification of specific genes, inevitably require the precise presumption of potential pathogens in each case, and pneumonia caused by unanticipated microorganisms might lead to inadequate antimicrobial treatments and unfortunate consequences. We herein report an immunocompromised female patient (69 years old) with fulminant pneumonia caused by Legionella (L.) pneumophila serogroup 8. Ordinary cultivation methods and urinary antigen detection failed to identify the causative organisms. Accordingly, DNA was extracted from the bronchoalveolar lavage fluid and used for the PCR-based cloning of the bacterial 16S rRNA gene. Sequencing analysis of the isolated clones revealed the predominance of L. pneumophila. Based on this information, the patient received an appropriate and successful antimicrobial treatment. In addition, L. pneumophila serogroup 8 was identified with culturing the bronchoalveolar lavage fluid and serotyping with L. pneumophila antisera. The 16S rRNA gene sequencing analysis can reveal the potential pathogens without any presumption about the organism, and can evaluate the kinds and ratio of bacterial species in each specimen. In conclusion, this cultivation-independent method is a potential diagnostic modality for pneumonia, especially in patients with rapidly progressive pneumonia or those who are immunocompromised.