5例军团菌重症肺炎患者的临床诊治分析

Analysis of clinical diagnosis and treatment of 5 patients with severe pneumonia caused by Legionella

目的分析军团菌重症肺炎患者的临床诊治特点,提高对该病的认识。方法回顾性分析广西壮族自治区人民医院2018年9月—2022年6月经宏基因组学二代测序技术(mNGS)诊断的军团菌重症肺炎合并严重脓毒症患者的临床资料,总结该病的临床特征、影像学表现及诊治要点,并进行相关文献复习。结果5例患者中男3例,女2例,年龄30~53岁。所有患者均起病较急,均有高热。4例有激素或免疫抑制剂使用史,3例有慢性肾功能不全病史。4例患者中性粒细胞显著升高、淋巴细胞计数下降。胸部影像表现均为双侧肺病变,以斑片状密度增高影或实变影为主,多数伴有胸腔积液。2例患者确诊军团菌经治疗后出现好转,其他3例出现多器官功能障碍,经治疗后效果欠佳自动出院。结论军团菌肺炎通常表现为高热伴肺部实变影,通过采集支气管肺泡灌洗液并外送mNGS检测能快速准确诊断。对于军团菌致重症肺炎患者早期足量给予喹诺酮类或大环内酯类药物联合其他药物治疗效果明显。

Objective To analyze the characteristics of the clinical diagnosis and treatment of patients with severe pneumonia caused by Legionella,so as to improve the understanding of the disease.Methods Clinical data of patients with Legionella severe pneumonia complicated with severe sepsis diagnosed by metagenomics next-generation sequencing(mNGS)in the People's Hospital of Guangxi Zhuang Autonomous Region from September 2018 to June 2022 were retrospectively analyzed.In addition,the clinical features,imaging manifestations,and diagnosis and treatment points of this disease were summarized,and relevant literatures were reviewed.Results 3 out of the 5 patients were male and 2 were female,aged 30 to 53 years.All patients had acute onsets and high fever.4 cases had a history of hormone or immunosuppressive drug use,and 3 cases had a history of chronic renal insufficiency.4 patients showed a significant increase in neutrophils and a decrease in lymphocyte count.Chest imaging features showed bilateral lung lesions,and they were mainly patchy density increasing shadows or consolidation shadows,most of which were accompanied by pleural effusion.2 patients were diagnosed with Legionella and showed improvement after treatment,while the other 3 experienced multiple organ dysfunction and discharged automatically due to poor treatment results.Conclusion Legionella pneumonia is usually characterized by high fever with consolidation lung shadow,and can be quickly and accurately diagnosed by collecting bronchoalveolar lavage fluid and delivering mNGS for detection.For patients with severe pneumonia caused by Legionella,early and sufficient administration of quinolones or macrolide combined with other drugs have obvious effect.