Xie Yirui, Ruan Bing, Jin Lingxiao, Zhu Biao
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.
Department of Infectious Diseases, People's Hospital of Pujiang County, Jinhua, China.
Front Med (Lausanne). 2021 Mar 29;8:653294. doi: 10.3389/fmed.2021.653294. eCollection 2021.
Pulmonary infections remain a significant cause of morbidity and mortality in immunocompromised patients. The pathogens spectrum of pulmonary infection that can affect patients with human immunodeficiency virus (HIV) is wide such as bacterial, fungal, viral, parasitic organisms, and so on. The risk of multi-pathogenic pneumonia is higher in HIV-infected patients. However, the fast and accurate diagnosis of multi-pathogenic pneumonia is challenging because of the limitations of current conventional tests. Here, we report a case of pneumonia due to and cytomegalovirus (CMV) in a 22-year-old male with newly diagnosed HIV infection. Blood tests revealed a low CD4 count, a chest computed tomography (CT) scan showed extensive ground-glass opacities in the bilateral lung with multiple cavity lesions in the left upper lung. Microscopic examination of stained sputum and bronchoalveolar lavage fluid (BALF) smear specimens did not find any pathogens. There was also no evidence of pathogens known to cause pneumonia in bacteria and fungi culture tests and virus antibodies such as EBV, CMV, and COVID-19. The nucleic acid of CMV in blood was reported by quantitative PCR. Next-generation sequencing (NGS) analysis of BALF specimens identified a large number of and CMV reads, and confirmed the diagnosis of pneumonia due to and CMV. Following the patient's treatment with anti-PCP and anti-CMV, the patient was cured and discharged. This case highlights the combined application of NGS in the clinical diagnosis of multi-pathogenic pneumonia in an HIV-infected patient. NGS is proposed as an important adjunctive diagnostic approach for identifying pathogens of multi-pathogenic pneumonia in HIV-infected patients.
肺部感染仍然是免疫功能低下患者发病和死亡的重要原因。可影响人类免疫缺陷病毒（HIV）患者的肺部感染病原体谱很广，如细菌、真菌、病毒、寄生虫等。HIV感染患者发生多重病原体肺炎的风险更高。然而，由于目前传统检测方法的局限性，快速准确地诊断多重病原体肺炎具有挑战性。在此，我们报告一例22岁新诊断为HIV感染的男性患者因卡氏肺孢子菌和巨细胞病毒（CMV）引起的肺炎。血液检查显示CD4细胞计数低，胸部计算机断层扫描（CT）显示双侧肺部广泛磨玻璃影，左上肺有多个空洞病变。对染色痰液和支气管肺泡灌洗（BALF）液涂片标本进行显微镜检查未发现任何病原体。细菌和真菌培养试验以及EBV、CMV和COVID-19等病毒抗体检测中也没有已知引起肺炎的病原体证据。通过定量PCR报告血液中CMV的核酸。对BALF标本进行二代测序（NGS）分析发现大量卡氏肺孢子菌和CMV读数，并确诊为卡氏肺孢子菌和CMV引起的肺炎。患者接受抗肺孢子菌肺炎和抗CMV治疗后治愈出院。 本病例强调了NGS在HIV感染患者多重病原体肺炎临床诊断中的联合应用。NGS被认为是识别HIV感染患者多重病原体肺炎病原体的重要辅助诊断方法。
