Metagenomic analysis identifying a polymicrobial pulmonary infection in a non-HIV immunocompromised patient: a case report.

IF 2.6 3区 医学 Q2 RESPIRATORY SYSTEM
Jing Duan, Jie Ding, Yupeng Wei, Yingxin Zhang, Zhiqing You, Ding Li, Chao Chen
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Abstract

Background: Polymicrobial pulmonary infections, common in immunocompromised patients, often manifest more severe symptoms than monomicrobial infections. Clinical diagnosis delays may lead to mortality, emphasizing the importance of fast and accurate diagnosis for these patients. Metagenomic next-generation sequencing (mNGS), as an unbiased method capable of detecting all microbes, is a valuable tool to identify pathogens, particularly in cases where infections are difficult to diagnosis using conventional methods.

Case presentation: A 50-year-old male patient was admitted due to cough, expectoration and dyspnea. CT scan revealed diffuse inflammatory and cavernous lung lesion, and blood examination suggested a polymicrobial infection. However, no etiology was found by routine examination. mNGS of bronchoalveolar lavage fluid(BALF)simultaneously detected the presence of Pneumocystis jirovecii (P.jirovecii), Aspergillus fumigates (A.fumigates), Nocardia farcinica (N.farcinica), Salmonella enterica subsp. enterica (S.enterica subsp. enterica), and cytomegalovirus (CMV). The patient was successfully treated with compound sulfamethoxazole (SMZ-TMP), cefoperazone/sulbactam (SCF), moxifloxacin (MXF), voriconazole (VCZ), and ganciclovir. The patient recovered after two weeks of anti-infection therapy and maintained good health at a six-month follow-up.

Conclusion: For immunocompromised patients with multiple infections and atypical symptoms, mNGS emerged as a reliable approach to pathogen detection and guiding antibiotic therapy.

宏基因组分析鉴定非hiv免疫功能低下患者的多微生物肺部感染:一个病例报告。
背景:多微生物肺部感染常见于免疫功能低下患者,通常表现出比单微生物感染更严重的症状。临床诊断延误可能导致死亡,强调快速准确诊断对这些患者的重要性。新一代宏基因组测序(mNGS)作为一种能够检测所有微生物的无偏方法,是鉴定病原体的宝贵工具,特别是在使用常规方法难以诊断感染的情况下。病例介绍:男性,50岁,因咳嗽、咳痰、呼吸困难入院。CT示弥漫性炎症及肺海绵状病变,血液检查提示多微生物感染。常规检查未发现病因。支气管肺泡灌洗液(BALF)的mNGS同时检测到乙氏肺囊虫(p.j rovecii)、烟熏曲霉(a.f fumigates)、farcinica诺卡菌(N.farcinica)、肠沙门氏菌亚种。肠芽孢杆菌以及巨细胞病毒(CMV)。患者成功应用复方磺胺甲恶唑(SMZ-TMP)、头孢哌酮/舒巴坦(SCF)、莫西沙星(MXF)、伏立康唑(VCZ)和更昔洛韦治疗。患者在抗感染治疗两周后恢复,并在6个月的随访中保持良好的健康状况。结论:对于多发感染且症状不典型的免疫功能低下患者,mNGS是一种可靠的病原体检测和指导抗生素治疗的方法。
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来源期刊
BMC Pulmonary Medicine
BMC Pulmonary Medicine RESPIRATORY SYSTEM-
CiteScore
4.40
自引率
3.20%
发文量
423
审稿时长
6-12 weeks
期刊介绍: BMC Pulmonary Medicine is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of pulmonary and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
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