Guo Yongzheng, Li Xiaofeng, Xiao Qianggu, Yang Jie, Tao Ran, Xu Lijun, Zhu Biao
The Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.
The Department of Infectious Diseases, Huzhou Central Hospital, Huzhou, Zhejiang, People's Republic of China.
Infect Drug Resist. 2023 Dec 22;16:7767-7773. doi: 10.2147/IDR.S441083. eCollection 2023.
pneumonia in HIV-infected patients is relatively unusual but is associated with a high mortality rate, as well as high rates of misdiagnosis and delayed diagnosis. Clinical metagenome next-generation sequencing (mNGS) may have potential for its accurate and timely diagnosis.
We retrospectively reviewed the medical records of three HIV-infected patients who presented with pneumonia in Zhejiang Province between January 2019 and December 2020. No specific clinical presentations or radiological manifestations were found in any of the patients. The detection of is 28-55 days earlier using mNGS on bronchoalveolar lavage fluid (BALF) compared to traditional culture methods. A combined treatment of rifabutin, clarithromycin, or azithromycin, and ethambutol did not provide timely relief of symptoms in these three patients. In the early stage of treatment, moxifloxacin and linezolid were used for several weeks. The average course of treatment for all three patients was close to 17 months.
We recommend early BALF mNGS for fast and accurate diagnosis of pneumonia in HIV-infected patients with low CD4 counts and long duration of symptoms. Further, moxifloxacin and linezolid may be beneficial in the early stage of treatment.
HIV感染患者的肺炎相对不常见，但死亡率高，误诊率和延迟诊断率也高。临床宏基因组下一代测序（mNGS）可能有助于其准确及时诊断。
我们回顾性分析了2019年1月至2020年12月在浙江省出现肺炎的3例HIV感染患者的病历。所有患者均未发现特异性临床表现或影像学表现。与传统培养方法相比，使用mNGS检测支气管肺泡灌洗液（BALF）可提前28 - 55天发现。利福布汀、克拉霉素或阿奇霉素与乙胺丁醇联合治疗未能及时缓解这3例患者的症状。治疗初期使用莫西沙星和利奈唑胺数周。所有3例患者的平均疗程接近17个月。
我们建议对CD4细胞计数低且症状持续时间长的HIV感染患者，早期进行BALF mNGS检测以快速准确诊断肺炎。此外，莫西沙星和利奈唑胺在治疗初期可能有益。
