Department of Infectious Diseases, the First Hospital, Jilin University, Changchun, 130021, Jilin, China.
Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.
BMC Infect Dis. 2020 Aug 17;20(1):608. doi: 10.1186/s12879-020-05341-8.
Invasive fungal pneumonia is a severe infectious disease with high mortality in immunocompromised patients. However, the clinical diagnosis of the pathogen(s) remains difficult since microbiological evidence is difficult to acquire.
Here, we report a case of pulmonary fungal infection detected by next-generation sequencing (NGS) of bronchoalveolar lavage fluid (BALF) in a 61-year-old male with corticosteroid-treated dermatomyositis. Cytomegalovirus and influenza A virus infections were confirmed by nucleic acid detection and treated with antiviral medicine. The patient had been diagnosed with severe pneumonia and treated with empiric broad-spectrum antibacterial and antifungal drugs before bronchoscopy was performed. The patient responded poorly to those empiric treatments. Three fungi were found by NGS in the BALF, namely, Pneumocystis jirovecii, Aspergillus fumigatus and Rhizopus oryzae. After adjusting the patient's treatment plan according to the NGS results, he improved significantly.
This case highlights the combined application of NGS and traditional tests in the clinical diagnosis of pulmonary invasive fungal disease. NGS is proposed as an important adjunctive diagnostic approach for identifying uncommon pathogens.
侵袭性肺部真菌感染是一种严重的传染病，免疫功能低下的患者死亡率很高。然而，由于难以获得微生物学证据，病原体的临床诊断仍然很困难。
在这里，我们报告了一例经支气管肺泡灌洗液（BALF）下一代测序（NGS）检测到的肺部真菌感染病例，该患者为 61 岁男性，患有皮质类固醇治疗的皮肌炎。通过核酸检测确认了巨细胞病毒和甲型流感病毒感染，并使用抗病毒药物进行治疗。在进行支气管镜检查之前，患者已被诊断为严重肺炎，并接受了经验性广谱抗菌和抗真菌药物治疗。患者对这些经验性治疗反应不佳。NGS 在 BALF 中发现了三种真菌，分别为卡氏肺孢子虫、烟曲霉和米根霉。根据 NGS 结果调整患者的治疗方案后，他的病情明显改善。
本病例强调了 NGS 与传统检测方法在肺部侵袭性真菌感染临床诊断中的联合应用。NGS 被提议作为一种重要的辅助诊断方法，用于识别不常见的病原体。
