二代测序诊断肺移植后耶氏肺孢子菌肺炎二例并文献复习

Pneumocystis jirovecii pneumonia diagnosed by next-genetation sequencing after lung transplantation:case report and literature review

目的探讨二代测序(NGS)技术在耶氏肺孢子菌肺炎(PCP)诊断方面的价值。方法对2例肺移植后PCP患者的痰液和肺泡灌洗液行NGS检测,发现耶氏肺孢子菌感染,报告此2例患者的临床资料、影像学特点、实验室检查和治疗情况,并在PubMed上以关键词"肺移植/实体器官移植"和"耶氏肺孢子菌"搜索并文献复习。结果以关键词"肺移植/实体器官移植"和"耶氏肺孢子菌"搜索共检索到6篇相关文献,其中病例报道3篇,共有66例肺移植患者合并耶氏肺孢子菌感染。PCP临床多表现为发热、不同程度呼吸困难,影像学可显示弥漫"磨玻璃"浸润影,CT是检测PCP的敏感手段;联合免疫荧光镜检/聚合酶链反应/血清1,3-β-D-葡聚糖可有效提高微生物检测准确率;此外,NGS可快速、精确地确定致病菌,指导针对性治疗,改善预后。复方磺胺甲基异噁唑(TMP/SMZ)为治疗首选药物,对于免疫抑制患者建议长期小剂量预防。结论 PCP好发于器官移植后免疫抑制的患者,NGS可帮助快速精确诊断,TMP/SMZ为治疗首选药物,治疗应早期足量。

Objective To explore the clinical value of next-generation sequencing(NGS) in the diagnosis of Pneumocystis jirovecii pneumonia(PCP).Methods Two patients with Pneumocystis jirovecii pneumonia after lung transplantation were detected by NGS in the sputum and bronchoalveolar lavage fluid.The clinical data,imaging features,laboratory examination and treatment of the two patients were reported.A systematic literature review was performed for similar published cases in PubMed database,using the keywords "lung transplantation/solid organ transplantation" and "Pneumocystis jirovecii".Results There were six references based on the keywords of "lung transplantation " and "Pneumocystis jirovecii ",of which three were case report.Sixty-six lung transplant patients were complicated with Pneumocystis jirovecii in total.The clinical manifestations of Pneumocystis jirovecii pneumonia were fever and dyspnea of different degrees.The diffuse "ground glass" infiltration could be shown on imaging.Computer tomography scan of chest was a sensitive method to detect PCP.Combined immunofluorescence microscope/PCR/serum 3-β-D-glucan could effectively improve the accuracy of microbiology detection.In addition,NGS could quickly and accurately identify pathogenic bacteria,give guidance for treatment and improve prognosis so as to benefit patients well.Trimethoprim/sulfamethoxazole(TMP/SMZ) was the preferred choice for the treatment of PCP patients.Conclusions Pneumocystis jirovecii pneumonia is more common in patients with immunodeficiency or immunosuppression.NGS can help rapid and accurate diagnosis,and the treatment should be early and sufficient.