Wang Wei, Yan Chun-Liang, Xue Qi-Shan
Department of respiratory medicine, Beijing Aerospace General Hospital, Beijing, China.
Vector Borne Zoonotic Dis. 2025 Jul;25(7):463-469. doi: 10.1089/vbz.2025.0009. Epub 2025 May 20.
This study aimed to analyze the clinical characteristics of five cases of pneumonia diagnosed using metagenomics next-generation sequencing (mNGS) and to provide help for its diagnosis and treatment. Five patients who were admitted to the department of Respiratory and Critical Care Medicine of Beijing Aerospace General Hospital between June 2020 and December 2021 and diagnosed with pneumonia using mNGS were selected, including one case with severe pneumonia. We analyzed the clinical characteristics, epidemiology, laboratory results, treatment, and prognosis of the five participating patients. The main clinical manifestations were high fever, dry cough, chest tightness, shortness of breath, and myalgia. All five patients had a history of contact with poultry. The white blood cell count was normal or slightly increased, the lymphocyte count was significantly decreased, and the percentage of neutrophil granulocyte, C-reactive protein (CRP), erythrocyte sedimentation rate, and procalcitonin were significantly increased. Chest computed tomography showed inflammatory infiltration and consolidation of one or more lung lobes, possibly accompanied by pleural effusion and liver function impairment. Bronchoscopy mainly showed congestion and edema of airway mucosa with less sputum in the airway. In all patients, we detected the nucleic acid sequences of in alveolar lavage fluid or sputum using mNGS and confirmed the diagnosis of pneumonia based on clinical manifestations and exposure history. After adjusting antibiotics to a moxifloxacin-based treatment regimen, the disease improved. The application of the mNGS assay enables us to make faster diagnoses of diseases so that timely medication can be administered, thus shortening the duration of a patient's illness. pneumonia has an acute onset, and fever and cough are common symptoms. A history of contact between the patient and birds is an important diagnostic clue; however, clinical symptoms and laboratory and imaging examinations lack specificity. The detection using mNGS of bronchoalveolar lavage fluid can quickly confirm the diagnosis and reduce missed diagnoses and misdiagnoses. Moxifloxacin-based therapy is effective, and patients require combination therapy if they have other bacterial infections.
本研究旨在分析5例采用宏基因组学下一代测序（mNGS）诊断的肺炎患者的临床特征，为其诊断和治疗提供帮助。选取2020年6月至2021年12月期间在北京航天总医院呼吸与危重症医学科住院并采用mNGS诊断为肺炎的5例患者，其中包括1例重症肺炎患者。我们分析了5例参与患者的临床特征、流行病学、实验室检查结果、治疗及预后情况。主要临床表现为高热、干咳、胸闷、气短及肌痛。所有5例患者均有禽类接触史。白细胞计数正常或略有升高，淋巴细胞计数显著降低，中性粒细胞百分比、C反应蛋白（CRP）、红细胞沉降率及降钙素原显著升高。胸部计算机断层扫描显示一个或多个肺叶有炎症浸润和实变，可能伴有胸腔积液和肝功能损害。支气管镜检查主要表现为气道黏膜充血水肿，气道内痰液较少。在所有患者中，我们采用mNGS检测肺泡灌洗液或痰液中的核酸序列，并根据临床表现和接触史确诊为肺炎。调整抗生素治疗方案为以莫西沙星为主后，病情好转。mNGS检测方法的应用使我们能够更快地诊断疾病，从而及时给药，缩短患者病程。肺炎起病急，发热和咳嗽是常见症状。患者与禽类的接触史是重要的诊断线索；然而，临床症状以及实验室和影像学检查缺乏特异性。采用mNGS检测支气管肺泡灌洗液可快速确诊，减少漏诊和误诊。以莫西沙星为主的治疗有效，若患者合并其他细菌感染则需要联合治疗。
