Metagenomic next-generation sequencing contributes to the diagnosis of mixed pulmonary infection: a case report.
Metagenomic next-generation sequencing contributes to the diagnosis of mixed pulmonary infection: a case report.
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宏基因组下一代测序有助于诊断混合肺部感染：病例报告。
DOI：
10.1186/s12941-022-00545-z
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发表时间：
2022-11-24
影响因子：
5.7
通讯作者：
Wang, Yuanli
中科院分区：
文献类型：
--
作者：
Qin, Ziqian;Zou, Yiwu;Huang, Zehe;Yu, Ning;Deng, Zhenfeng;Chen, Zhencheng;Wang, Yuanli
关键词：
肺隐球菌病和混合性肺部感染由于临床表现重叠，且无特异性，诊断困难。在PC和混合性肺部感染的临床诊断方面，常规检测存在检测周期长、病原体范围有限、灵敏度低等局限性。宏基因组学下一代测序（mNGS）是一种新兴而强大的方法，可以在不培养的情况下检测病原体，从而在更短的时间内诊断已知和不明原因的感染。一名43岁女性在咳嗽一个月后入院。入院时，对比增强胸部CT显示她的右肺有多个结节和斑块，以及空洞形成。血常规示白色细胞计数（主要为中性粒细胞）、CRP和ESR明显升高，提示患者处于感染期。血清CrAg-LFA试验呈阳性。最初，她被诊断为不明原因的肺部感染。收集支气管肺泡灌洗液（BALF）样本进行微生物培养、免疫学试验和mNGS。微生物培养和免疫学检测均为阴性，而mNGS检测到纹状体棒状杆菌、铜绿假单胞菌、肺炎链球菌和新型隐球菌。诊断修订为PC和细菌性肺炎。经美洛西林、氟康唑靶向抗感染治疗后，肺部感染病灶痊愈。在2个月后的随访中，患者的症状消失。在这里，我们证明了mNGS能够准确区分隐球菌和M。mNGS能快速、准确地检测细菌和真菌混合感染的病原体。此外，mNGS的结果也有可能调整抗感染治疗。在线版本包含补充材料，可通过10.1186/s12941-022-00545-z获得。
Pulmonary cryptococcosis (PC) and mixed pulmonary infection are difficult to be diagnosed due to the non-specificity and their overlapping clinical manifestations. In terms of the clinical diagnosis of PC and mixed pulmonary infection, conventional tests have limitations such as a long detection period, a limited range of pathogens, and low sensitivity. Metagenomics next-generation sequencing (mNGS) is a nascent and powerful method that can detect pathogens without culture, to diagnose known and unexplained infections in reduced time. A 43-year-old female was admitted to the hospital after suffering from a cough for one month. At the time of admission, a contrast-enhanced chest CT revealed multiple nodules and plaques in her right lung, as well as the formation of cavities. The blood routine assays showed evidently increased white blood cell count (mainly neutrophils), CRP, and ESR, which suggested she was in the infection phase. The serum CrAg-LFA test showed a positive result. Initially, she was diagnosed with an unexplained pulmonary infection. Bronchoalveolar lavage fluid (BALF) samples were collected for microbial culture, immunological tests and the mNGS. Microbial culture and immunological tests were all negative, while mNGS detected Corynebacterium striatum, Pseudomonas aeruginosa, Streptococcus pneumoniae, and Cryptococcus neoformans. The diagnosis was revised to PC and bacterial pneumonia. Lung infection lesions were healed after she received targeted anti-infection therapy with mezlocillin and fluconazole. In a follow-up after 2 months, the patient’s symptoms vanished. Here, we demonstrated that mNGS was capable of accurately distinguishing Cryptococcus from M. tuberculosis in pulmonary infection, and notably mNGS was capable of swiftly and precisely detecting pathogens in mixed bacterial and fungal pulmonary infection. Furthermore, the results of mNGS also have the potential to adjust anti-infective therapies. The online version contains supplementary material available at 10.1186/s12941-022-00545-z.
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DOI：
10.1016/s0140-6736(10)61459-6
发表时间：
2011-04-09
期刊：
Lancet (London, England)
影响因子：
--
作者：
Ruuskanen O;Lahti E;Jennings LC;Murdoch DR
通讯作者：
Murdoch DR
影响因子：
3.1
作者：
Xiong, Chunlin;Lu, Jianguo;Chen, Ting;Xu, Rui
通讯作者：
Xu, Rui
DOI：
10.1177/0300060518769541
发表时间：
2018-07
期刊：
The Journal of international medical research
影响因子：
--
作者：
Deng H;Zhang J;Li J;Wang D;Pan L;Xue X
通讯作者：
Xue X
影响因子：
3.7
作者：
Pan L;Pan XH;Xu JK;Huang XQ;Qiu JK;Wang CH;Ji XB;Zhou Y;Mao MJ
通讯作者：
Mao MJ
影响因子：
8.4
作者：
Jarvis, Joseph N.;Wainwright, Helen;Meintjes, Graeme
通讯作者：
Meintjes, Graeme