mNGS在15例海南危重型立克次体病早期救治中的价值

Early diagnostic value of mNGS for 15 cases with critical rickettsial disease in Hainan

目的探讨宏基因组二代测序(mNGS)在危重型不典型的立克次体感染者早期救治中的应用价值。方法收集2020年1月至2022年8月在海南省人民医院住院治疗临床诊断危重症立克次体患者的临床特征、血生化结果、外斐反应结果、影像学资料及mNGS结果,进行回顾性分析,使用Fisher精确性检验比较mNGS和外斐反应的阳性率。结果15例立克次体病患者中均有发热症状,头痛12例,但具有诊断意义的典型皮疹或焦痂仅为3例,发生脓毒症休克6例,多器官功能障碍15例;血液mNGS阳性15例,其中10例患者在血液中检测出普氏立克次体(恙虫病东方体),其余5例检测出莫氏立克次体,mNGS阳性率显著高于外斐反应(15/15比0,P<0.001)。所有患者在确诊后均被给予多西环素等治疗,其中14例好转出院,1例因病情危重、放弃治疗出院后1周死亡。结论mNGS能够提高常规检测结果为阴性的非典型立克次体的检出率,可为危重型立克次体病患者早期诊断、早期抗感染治疗提供参考。

Objective To explore the clinical utility of metagenomic next-generation sequencing(mNGS)for patients with critically ill atypical rickettsial infections in the early diagnosis and therapy.Methods From Jan 2020 to Aug 2022,clinical features,blood biochemical results,imaging data and mNGS results in patients with unexplained critical illnesses were collected and analyzed retrospectively.Fisher's exact test was used to compare the positive rate of mNGS and weil felix reaction.Results All 15 patients with rickettsial disease had fever,12 cases had headache,but only 3 had a typical rash or scab of diagnostic significance,6 had septic shock and all had multi-organ dysfunction;blood mNGS tests were positive in 15 cases,of which 10 had Orientia tsutsugamushi detected in their blood and the remaining five had Rickettsia moschata detected in their blood.The positive rate of mNGS was significantly higher than that of the weil felix reaction(15/15 vs 0,P<0.001).All patients were given doxycycline and other treatments after diagnosis,of which 14 improved and were discharged,and one died 1 week after discharge due to critical condition and abandonment of treatment.Conclusion mNGS can improve the detection rate of atypical rickettsiae in patients with negative routine test results,which can provide valuable reference basis for early diagnosis and early anti-infection treatment of patients with critical rickettsial disease.