Lei Cheng, Zhou Xianglin, Ding Shuizi, Xu Yingjie, Yang Binyi, Guo Wei, Song Min, Yang Min, Jia Yunan, Luo Hong
Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China.
Research Unit of Respiratory Disease, Central South University, Changsha, China.
Front Med (Lausanne). 2022 Jan 28;9:819425. doi: 10.3389/fmed.2022.819425. eCollection 2022.
spp. has been well-recognized as an important cause of community-acquired pneumonia. Current community-acquired pneumonia guidelines recommended covering the treatment of because of the high mortality associated with inadequate antibiotic treatments. However, the symptom of pneumonia is non-specific, and routine diagnostic tests exhibit low sensitivity for spp., especially for non- serogroup 1 strains.
We report a 53-year-old man without underlying diseases admitted to respiratory intensive care unit because of severe community-acquired pneumonia and respiratory failure. Although, the results of routine culture of bronchoalveolar lavage fluid and the urinary antigen test were all negative, metagenomic next-generation sequencing (mNGS) identified a great amount of DNA and RNA sequences of in bronchoalveolar lavage fluid while negative in blood sample. The presence of in bronchoalveolar lavage fluid was further confirmed by polymerase-chain-reaction and Sanger sequencing.
has rarely been reported in patients with community-acquired pneumonia mainly due to lack of diagnostic test for non- pneumophila serogroup 1 strains. This is the first report of pneumonia in an immunocompetent patient detected by mNGS, which indicates that mNGS is a high-resolution and sensitive assay for the diagnosis and surveillance of infection.
嗜肺军团菌已被公认为社区获得性肺炎的重要病因。由于抗生素治疗不足会导致高死亡率，当前社区获得性肺炎指南建议涵盖嗜肺军团菌的治疗。然而，嗜肺军团菌肺炎的症状不具有特异性，常规诊断检测对嗜肺军团菌的敏感性较低，尤其是对非1血清型菌株。
我们报告一名53岁无基础疾病的男性，因严重社区获得性肺炎和呼吸衰竭入住呼吸重症监护病房。尽管支气管肺泡灌洗 fluid 的常规培养结果和嗜肺军团菌尿抗原检测均为阴性，但宏基因组下一代测序（mNGS）在支气管肺泡灌洗 fluid 中鉴定出大量嗜肺军团菌的DNA和RNA序列，而血样中为阴性。支气管肺泡灌洗 fluid 中嗜肺军团菌的存在通过聚合酶链反应和桑格测序进一步得到证实。
嗜肺军团菌肺炎在社区获得性肺炎患者中很少被报道，主要是由于缺乏针对非嗜肺军团菌1血清型菌株的诊断检测。这是首例通过mNGS在免疫功能正常患者中检测到嗜肺军团菌肺炎的报告，表明mNGS是一种用于诊断和监测嗜肺军团菌感染的高分辨率和敏感检测方法。
