Zhang Yuan, Zeng Zhaoshang, Li Fenghui, Peng Zhiyun, Xia Han, Zeng Yunyi, Chen Haimin, Wang Yingjing, Xie Weining, Zhang Yanhua, Tang Zhongxiang
Department of Intensive Care Unit, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Foshan 528200, China.
Department of Scientific Affairs, Hugobiotech Co., Ltd, Beijing 100176, China.
Open Life Sci. 2022 Aug 17;17(1):938-943. doi: 10.1515/biol-2022-0094. eCollection 2022.
It remains a huge challenge for clinicians to diagnose pneumonia (PJP) by a conventional method, which leads to delay in diagnosing PJP, accounting for higher mortality in patients with rheumatoid arthritis (RA). A 69-year-old woman, who suffered from RA for years, developed acute respiratory failure. The computed tomography scan showed diffused effusion and ground glass opacity in both lungs, which could not be differentiated from interstitial pneumonia. Metagenomic next-generation sequencing (mNGS) revealed in both serum and bronchoalveolar lavage fluid with reads per million (RPM) of 17 and 437, while other diagnostic tests did not detect any pathogenic microorganism. The results were verified by quantitative polymerase chain reaction (mtSSU region) against the same samples. The DNA RPM of declined notably after treatment with trimethoprim/sulfamethoxazole. The patient was discharged without treatment and finally passed away. This case fully highlights the sensitivity of mNGS in early diagnosis of PJP, which is of great significance for prognosis and treatment. Nonetheless, the clinical application of mNGS is worth further standardization and normalization.
对于临床医生而言，采用传统方法诊断肺炎（肺孢子菌肺炎，PJP）仍然是一项巨大挑战，这会导致PJP诊断延迟，在类风湿关节炎（RA）患者中造成更高的死亡率。一名69岁女性，患RA多年，出现急性呼吸衰竭。计算机断层扫描显示双肺弥漫性渗出和磨玻璃影，无法与间质性肺炎相鉴别。宏基因组下一代测序（mNGS）在血清和支气管肺泡灌洗液中均检测到，每百万读取数（RPM）分别为17和437，而其他诊断测试未检测到任何致病微生物。通过针对相同样本的定量聚合酶链反应（mtSSU区域）验证了结果。经甲氧苄啶/磺胺甲恶唑治疗后，DNA的RPM显著下降。该患者未接受治疗出院，最终死亡。该病例充分凸显了mNGS在PJP早期诊断中的敏感性，这对预后和治疗具有重要意义。尽管如此，mNGS的临床应用仍值得进一步规范和标准化。
