Shi Dandan, Xiao Basang, Wang Heyan, Kong Xian, Baima Yangjin, Yang Li, Zhou Hourong, Zhang Yuntao, Wang Heyan, He Hangyong
Department of Pulmonary Medicine, Lhasa People's Hospital, Lhasa, Tibet Autonomous Region, China.
School of Basic Medicine, Guizhou University of Traditional Chinese Medicine, Guiyang, 550002, China.
BMC Infect Dis. 2025 Apr 16;25(1):538. doi: 10.1186/s12879-025-10889-4.
Some studies of community-acquired pneumonia (CAP) have reported that human rhinovirus (HRV) is the most common virus in viral pneumonia in immunocompetent adults. Secondary bacterial and fungal infections are increasingly recognized complications of HRV infection that have substantial morbidity and mortality. We report a novel case of a co-infection of Streptococcus pneumoniae (S. pneumoniae) associated with HRV pneumonia that had successful diagnosis with combined target next generation sequencing (NGS) and percutaneous lung puncture biopsy (PLPB).
A 62-year-old female was admitted with productive cough, dyspnea and respiratory failure. She was initially diagnosed with severe pneumonia caused by HRV infection by targeted NGS from bronchial-alveolar lavage fluid. After initial clinical improvement treated by high flow nasal cannula (HFNC) and antibiotics, the patient's condition worsened again after her discharge, with persistent dyspnea and refractory hypoxemia. Chest computed tomography showed areas of consolidation and ground glass opacification. Despite empirical antibiotics for a suspected secondary co-infection, her condition showed no significant improvement. A PLPB was performed, and targeted NGS for the lung tissue was positive only for S. pneumoniae. Targeted NGS of her sputum was positive for S. pneumoniae, Aspergillus fumigatus and type A HRV. The patient was treated with linezolid, voriconazole and methylprednisolone. HFNC was weaned on day 57, and she was discharged with good lung recovery.
Our case demonstrates the diagnostic utility of combined targeted NGS and CT-guided PLPB in resolving refractory pneumonia with overlapping viral and bacterial etiologies. Co-infection with these two pathogens should be considered in the differential diagnosis of patients with consolidation, wheezing and respiratory failure following severe HRV infection. The combination of targeted NGS and CT-guided PLPB should be reserved for diagnostically challenging cases refractory to conventional methods.
一些关于社区获得性肺炎（CAP）的研究报告称，人鼻病毒（HRV）是免疫功能正常的成年人病毒性肺炎中最常见的病毒。继发性细菌和真菌感染是HRV感染日益被认识到的并发症，具有相当高的发病率和死亡率。我们报告了一例与HRV肺炎相关的肺炎链球菌（S. pneumoniae）合并感染的新病例，该病例通过联合靶向二代测序（NGS）和经皮肺穿刺活检（PLPB）成功诊断。
一名62岁女性因咳痰、呼吸困难和呼吸衰竭入院。最初通过支气管肺泡灌洗液体的靶向NGS诊断为HRV感染引起的重症肺炎。在通过高流量鼻导管（HFNC）和抗生素进行初始临床改善后，患者出院后病情再次恶化，伴有持续呼吸困难和难治性低氧血症。胸部计算机断层扫描显示实变区和磨玻璃样混浊。尽管对疑似继发性合并感染使用了经验性抗生素，但她的病情没有明显改善。进行了PLPB，肺组织的靶向NGS仅对肺炎链球菌呈阳性。她痰液的靶向NGS对肺炎链球菌、烟曲霉和A型HRV呈阳性。患者接受了利奈唑胺、伏立康唑和甲泼尼龙治疗。HFNC在第57天撤离，她出院时肺部恢复良好。
我们的病例证明了联合靶向NGS和CT引导下PLPB在解决病因重叠的病毒性和细菌性难治性肺炎中的诊断效用。在对严重HRV感染后出现实变、喘息和呼吸衰竭的患者进行鉴别诊断时，应考虑这两种病原体的合并感染。靶向NGS和CT引导下PLPB的联合应用应保留用于对传统方法难治的诊断挑战性病例。
