Bao Qiu-Hong, Yu Li, Ding Jian-Jun, Chen Ying-Jun, Wang Jun-Wei, Pang Jian-Ming, Jin Qi
Department of Respiratory and Critical Medicine, Tiantai Hospital of Hangzhou Medical College, Tiantai 317200, Zhejiang Province, China.
Department of Infectious Disease, Tiantai Hospital of Hangzhou Medical College, Tiantai 317200, Zhejiang Province, China.
World J Clin Cases. 2021 Mar 16;9(8):1901-1908. doi: 10.12998/wjcc.v9.i8.1901.
is an uncommon pathogen for adult severe community-acquired pneumonia and its nonspecific manifestations and limited diagnostic tests make it difficult to identify. Although conventional penicillin remains efficacious to treat leptospirosis, failure in early diagnosis and treatment can lead to progression into a deadly syndrome with multiple organ dysfunction. Next generation sequencing is of great value to understand cases with infection of unknown cause, which could help in the diagnosis of uncertain infection.
We recently managed a patient with fever, cough and dyspnea on admission that progressed into persistent adult respiratory distress syndrome, hemoptysis and hematuria after admission. In this case, the rare infection was clouded by the positive influenza tests at admission, delaying early -targeted antibiotics administration. Next generation sequencing, a novel molecular diagnostic tool, provided a key hint to uncover the crucial pathogen, , further supported by the possible occupational exposure history. Subsequent conventional penicillin and mechanical respiratory support were administrated to cure the patient successfully without any sequela.
Clinicians must pay attention to possible exposure history and keep uncommon in mind when managing pneumonia with unknown causes.
是成人重症社区获得性肺炎的一种罕见病原体，其非特异性表现和有限的诊断测试使其难以识别。尽管传统青霉素对治疗钩端螺旋体病仍然有效，但早期诊断和治疗失败可导致进展为伴有多器官功能障碍的致命综合征。下一代测序对于了解病因不明的感染病例具有重要价值，有助于诊断不确定的感染。
我们最近收治了一名入院时发热、咳嗽和呼吸困难的患者，入院后进展为持续性成人呼吸窘迫综合征、咯血和血尿。在该病例中，入院时流感检测呈阳性掩盖了这种罕见感染，延迟了早期针对性抗生素的使用。下一代测序作为一种新型分子诊断工具，为揭示关键病原体提供了关键线索，可能的职业暴露史进一步支持了这一点。随后给予传统青霉素和机械通气支持，成功治愈患者，无任何后遗症。
临床医生在处理病因不明的肺炎时，必须注意可能的暴露史，并牢记这种罕见病原体。
