宏基因测序协助诊断肾移植术后曲霉菌腰椎炎一例并文献复习

One case report of aspergillus lumbar spine infection diagnosed by metagenomic next-generation sequencing after renal transplantation and literature review

目的探讨宏基因在器官移植受者术后发生难治性感染中的应用及价值。方法回顾性分析山西省第二人民医院1例肾移植术后腰椎感染受者的诊治经过,并复习相关文献。受者为63岁男性,肾移植术后2个月腰痛,腰椎核磁示腰椎感染,多次外科手术联合抗细菌、抗结核治疗效果欠佳,治疗前后多次行传统病原微生物检测,均未发现阳性菌。遂取腰椎脓液行宏基因二代测序。结果腰椎分泌物宏基因检测提示曲霉菌感染。给予伏立康唑抗真菌治疗后受者症状好转。结论腰椎真菌感染发病率低,影像学表现不典型,易误诊。宏基因检测助于及时诊断,指导治疗。结合文献复习,证实宏基因检测在疑难、罕见感染性疾病中的应用价值。

Objective To explore the application and value of metagenomic next-generation sequencing(mNGS)in refractory infection after organ transplantation.Methods A case report discussed about a patient with lumbar spine infection after kidney transplantation and the relevant literature was reviewed.The recipient was a 63-year-old man with low back pain after kidney transplantation.Lumbar spine magnetic resonance imaging showed lumbar spine infection.Multiple operations plus antibacterial and antituberculosis treatments were ineffective.Before and after treatment,numerous tests of traditional pathogenic microorganisms failed to detect any positive bacteria.Results The detection of lumbar secretion by mNGS suggested aspergillus infection.The symptoms improved after dosing of voriconazole.Conclusions The incidence of fungal infection of lumbar spine is low.The imaging manifestations are non-typical so that it is easy to misdiagnose.mNGS helps to timely diagnose and guide treatment.With a review of the literature,mNGS has some application value for some difficult and rare infectious diseases.