Lu Le, Zhao Zhiming, Liu Chunli, Zhang Beibei, Fu Mengya, Wang Dongyi, Shen Junyi, Cai Hui, Shang Wei
Department of Integrative Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, China.
Heliyon. 2024 Aug 6;10(15):e35681. doi: 10.1016/j.heliyon.2024.e35681. eCollection 2024 Aug 15.
is an aerobic gram-positive bacterium that is pathogenic to humans. It usually causes local and adjacent tissues' diseases at the entry of infection (most commonly occur in the lungs, skin, or central nervous system), which can also spread to other organs through the bloodstream such as joints, kidneys, and liver. However, these infections are often seen as opportunistic that occur in immunocompromised patients. Here, we report for the first time two immunocompetent patients lacking evidence of local infections, with multiple lymph node enlargements and fever as main clinical manifestations, finally diagnosed as nocardiosis by Metagenomic Next-Generation Sequencing testing (mNGS) from formalin-fixed and paraffin-embedded (FFPE) lymph node tissue, after all the other standard tests were negative. Both patients recovered after receiving anti-nocardia therapies. These two cases indicates that in healthy population, there may be more potential nocardia infections than we expected. Multiple lymph node enlargements and fever suggest a possibility of nocardiosis, especially in patients with fever of unknown origin (FUO). mNGS detection from FFPE lymph node tissue is an accurate, reliable and traceable method for diagnosis of nocardiosis.
是一种对人类致病的需氧革兰氏阳性菌。它通常在感染入口处引起局部及邻近组织的疾病（最常见于肺部、皮肤或中枢神经系统），也可通过血液循环扩散至其他器官，如关节、肾脏和肝脏。然而，这些感染在免疫功能低下的患者中常被视为机会性感染。在此，我们首次报告了两名免疫功能正常的患者，他们没有局部感染的证据，以多个淋巴结肿大和发热为主要临床表现，在所有其他标准检查均为阴性后，通过对福尔马林固定石蜡包埋（FFPE）淋巴结组织进行宏基因组下一代测序检测（mNGS）最终确诊为诺卡菌病。两名患者在接受抗诺卡菌治疗后均康复。这两例病例表明，在健康人群中，可能存在比我们预期更多的潜在诺卡菌感染。多个淋巴结肿大和发热提示诺卡菌病的可能性，特别是在不明原因发热（FUO）患者中。对FFPE淋巴结组织进行mNGS检测是诊断诺卡菌病的一种准确、可靠且可溯源的方法。
