成人重症军团菌肺炎误诊分析

Misdiagnosed Analysis of Severe Legionella Pneumonia in Adults

目的分析成人重症军团菌肺炎误诊原因,总结防范误诊措施。方法回顾性分析2017年2月—2021年5月收治的4例成人重症军团菌肺炎的临床资料。结果本组首诊误诊率100%。患者主要表现为发热和气短,肺外以乏力、肌肉疼痛、头痛为主要表现。本组4例均误诊为细菌性肺炎,误诊时间8 d~1个月。3例经支气管肺泡灌洗液宏基因组二代测序,1例经院外军团菌尿抗原检测确诊为重症军团菌肺炎。1例危重患者行气管插管有创呼吸机辅助通气,3例给予高流量湿化治疗仪治疗。4例均给予盐酸莫西沙星注射液治疗。3例治愈,1例正在随访中。结论重症军团菌肺炎病情进展快,易出现呼吸衰竭,严重者会危及生命,因此对短期内肺部感染呈进行性加重,且伴有肺外表现的患者,应尽早行支气管肺泡灌洗液宏基因组二代测序检查以明确诊断。

Objective To analyze misdiagnosed causes of adult patients with severe legionella pneumonia and to summarize preventive measures.Methods Clinical data of 4 adult patients with severe Legionella pneumonia admitted between February 2017 and May 2021 was retrospectively analyzed.Results The misdiagnosed rate of the initial diagnosis was 100%in this group.The main manifestations of the patient were fever and shortness of breath,and the main extrapulmonary manifestations were fatigue,muscle pain and headache.All the 4 patients in this group were all misdiagnosed as having bacterial pneumonia,and the misdiagnosed ranged was from 8 d to 1 month.Three patients were sequenced by second-generation metagenomics of bronchoalveolar lavage fluid,and one patient received out-of-hospital Legionella urine antigen test,and then all patients were confirmed as having severe Legionella pneumonia.One critically ill patient underwent tracheal intubation and invasive ventilator-assisted ventilation,while other 3 patients were treated with a high-flow humidification therapy instrument.All four patients were treated with Moxifloxacin Hydrochloride Injection,and then 3 patients cured,and 1 was under follow-up.Conclusion The condition of severe Legionella pneumonia progresses rapidly,and respiratory failure is prone to occur,and condition of severe patients can be life-threatening.Therefore,patients with progressively aggravated lung infections in the short term accompanied by extrapulmonary manifestations should be given second-generation metagenomics of bronchoalveolar lavage fluid as early as possible to confirm the diagnosis.