Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Ann Med. 2024 Dec;56(1):2428433. doi: 10.1080/07853890.2024.2428433. Epub 2024 Nov 14.
Detection and diagnosis of () pneumonia is often overlooked due to conventional methods limitations and similarity to other atypical community acquired pneumonia (CAP). Using mNGS, we aimed to distinguish psittacosis from legionellosis for early pneumonia diagnosis and better prognosis.
Thirty-seven patients diagnosed with atypical CAP were enrolled in this retrospective study, including 14 pneumonia and 23 () pneumonia. We collected and compared baseline, lab results, radiology imaging, conventional microbiological methods and more importantly, mNGS results of clinical samples, as well as the treatments and prognosis between psittacosis and legionellosis.
Patients with and had similar symptoms and were presented with high levels of inflammatory markers. However, patients with pneumonia were more likely to have exposure to birds or parrots [11 (78.6%) vs. 2 (8.7%), < 0.001], had higher proportions of fever and chill ( = 0.015 and 0.035), higher levels of hemoglobin and albumin ( = 0.002 and 0.018) compared with those with . Of 14 patients, only one had positive IgM antibody, with no positive cultures. Early identification of pathogens by mNGS method contributed to timely antibiotics' adjustment and better outcomes then, yet with similar hospital mortality between two groups [7.1% (1/14) vs. 34.8% (8/23), = 0.112].
Early mNGS detection of atypical pathogens in multiple samples improves on traditional methods, promptly adjust empirical antimicrobial treatment to pathogen-targeted antibiotics, further improve prognosis.
由于传统方法的局限性和与其他非典型社区获得性肺炎（CAP）的相似性，鹦鹉热衣原体肺炎的检测和诊断经常被忽视。本研究旨在通过使用宏基因组二代测序（mNGS）来区分鹦鹉热和军团菌肺炎，以实现早期肺炎诊断和改善预后。
本回顾性研究纳入了 37 名被诊断为非典型 CAP 的患者，包括 14 例鹦鹉热衣原体肺炎和 23 例军团菌肺炎。我们收集并比较了基线、实验室结果、影像学表现、传统微生物学方法，更重要的是，比较了临床样本的 mNGS 结果，以及鹦鹉热和军团菌肺炎的治疗和预后。
鹦鹉热衣原体肺炎和军团菌肺炎患者的症状相似，炎症标志物水平较高。然而，鹦鹉热衣原体肺炎患者更有可能接触过鸟类或鹦鹉[11 例（78.6%）比 2 例（8.7%）， < 0.001]，更可能出现发热和寒战（ = 0.015 和 0.035），血红蛋白和白蛋白水平更高（ = 0.002 和 0.018）。14 例鹦鹉热衣原体肺炎患者中，仅有 1 例 IgM 抗体阳性，无阳性培养。mNGS 方法早期识别病原体有助于及时调整抗生素治疗，从而改善预后，但两组的住院死亡率相似[7.1%（1/14）比 34.8%（8/23）， = 0.112]。
早期从多个样本中检测出非典型病原体，通过 mNGS 方法可以改善传统方法的不足，及时调整经验性抗菌治疗为针对病原体的抗生素治疗，进一步改善预后。
