Ye Mingzhi, Wei Wei, Yang Zhikai, Li Yingzhen, Cheng Shaomin, Wang Kang, Zhou Tianliangwen, Sun Jingmeng, Liu Sha, Ni Na, Jiang Hui, Jiang Hua
BGI-Guangdong, BGI-Shenzhen, Guangzhou, 510006, China.
BGI-Guangzhou, Guangzhou Key Laboratory of Cancer Trans-Omics Research, Guangzhou, China.
BMC Infect Dis. 2016 Jan 8;16:5. doi: 10.1186/s12879-015-1306-0.
The rapid determination of pathogenic agent is very important to clinician for guiding their clinical medication. However, current diagnostic methods are of limitation in many aspects, such as detecting range, time-consuming, specificity and sensitivity. In this report, we apply our new-developing pathogen detection method to clarify that Propionibacterium acnes is the causative agent of a two-year-old boy with juvenile myelomonocytic leukemia presenting clinical symptoms including serious rash and hyperpyrexia while traditional clinical methods of diagnosis fail to detect the pathogenic agent and multiple antimicrobial drugs are almost ineffective Propionibacterium acnes is confirmed to be the infectious agent by quantitative real-time polymerase chain reaction.
After haploidentical hematopoietic stem cell transplantation, a two-year-old boy with juvenile myelomonocytic leukemia presented to a pediatrist in a medical facility with hyperpyrexia and red skin rash which later changed to black skin rash all over his body. Traditional diagnostic assays were unrevealing, and several routine antimicrobial treatments were ineffective, including the vancomycin, meropenem, tobramycin, cefepime and rifampin. In this case, pediatrist resorted to the next-generation sequencing technology for uncovering potential pathogens so as to direct their use of specific drugs against pathogenic bacteria. Therefore, based on the BGISEQ100 (Ion Proton System) which performed sequencing-by-synthesis, with electrochemical detection of synthesis, and each such reaction coupled to its own sensor, which are in turn organized into a massively parallel sensor array on a complementary metal-oxidesemiconductor chip, we detect and identify the potential pathogens. As a result, we detected a significantly higher abundance of skin bacteria Propionibacterium acnes in patient's blood than controls. It had been reported that patients infected by Propionibacterium acnes almost always had history of immunodeficiency, trauma or surgery. Considering this possible cause, antimicrobial treatment was adjusted to target this rare opportunistic pathogen. Fever and black skin rashes were rapidly reduced after administrating specific drugs against Propionibacterium acnes.
This case showed our new-developing pathogen detection method was a powerful tool in assisting clinical diagnosis and treatment. And it should be paid more attention to Propionibacterium acnes infection in clinical cases.
快速确定病原体对临床医生指导临床用药非常重要。然而，目前的诊断方法在许多方面存在局限性，如检测范围、耗时、特异性和敏感性等。在本报告中，我们应用新开发的病原体检测方法，以明确痤疮丙酸杆菌是一名两岁患青少年型骨髓单核细胞白血病男孩的病原体，该男孩出现严重皮疹和高热等临床症状，而传统临床诊断方法未能检测到病原体，多种抗菌药物治疗几乎无效。通过定量实时聚合酶链反应确认痤疮丙酸杆菌为感染病原体。
一名两岁患青少年型骨髓单核细胞白血病男孩在单倍体造血干细胞移植后，因高热和皮肤红疹就诊于一家医疗机构的儿科医生处，随后红疹遍布全身并转变为黑色皮疹。传统诊断检测未发现病原体，包括万古霉素、美罗培南、妥布霉素、头孢吡肟和利福平在内的几种常规抗菌治疗均无效。在此病例中，儿科医生采用下一代测序技术来发现潜在病原体，以便指导使用针对病原菌的特定药物。因此，基于BGISEQ100（Ion Proton系统），该系统通过合成进行测序，采用电化学合成检测，每个这样的反应都与自己的传感器相连，这些传感器又在互补金属氧化物半导体芯片上组织成大规模并行传感器阵列，我们检测并鉴定了潜在病原体。结果，我们检测到患者血液中痤疮丙酸杆菌这种皮肤细菌的丰度显著高于对照组。据报道，感染痤疮丙酸杆菌的患者几乎都有免疫缺陷、创伤或手术史。考虑到这一可能原因，调整抗菌治疗以针对这种罕见的机会性病原体。在使用针对痤疮丙酸杆菌治疗的特定药物后，发热和黑色皮疹迅速消退。
本病例表明我们新开发的病原体检测方法是辅助临床诊断和治疗的有力工具。临床病例中应更多关注痤疮丙酸杆菌感染。
