宏基因二代测序诊断侵袭性肺曲霉病1例报道

Diagnosis of invasive pulmonary aspergillosis by metagenomic next-generation sequencing:a case report

侵袭性肺曲霉病在临床中难以与其他肺部感染相鉴别,易误诊或漏诊。现报道运用宏基因二代测序技术诊断侵袭性肺曲霉病1例,以探讨宏基因二代测序技术对临床侵袭性肺曲霉病患者的诊断价值。患者主要临床表现为高热、咳嗽咳痰,痰中带血,入院后初步诊断为“细菌性肺炎”,先后予头孢哌酮钠舒巴坦钠、美罗培南,效果不佳,相关检查未获得充足病原学证据,遂行宏基因二代测序技术及病理检查,结果提示肺曲霉菌感染,调整抗菌药物为伏立康唑,治疗后患者好转出院。临床中对于常规抗生素治疗效果不佳的肺部感染患者,应考虑真菌感染的可能,若通过常规检查未能明确致病菌,应重视宏基因二代测序技术的诊断价值。

Invasive pulmonary aspergillosis is difficult to distinguish from other pulmonary infections in clinic,and is easy to be misdiagnosed or missed.This paper report,a case of invasive pulmonary aspergillosis diagnosed by macrogene second generation sequencing,to investigate the diagnostic value of metagenomic next-generation sequencing in patients with invasive pulmonary aspergillosis.The main clinical manifestations of the patient were high fever,cough,and sputum with blood,after admission,the initial diagnosis was“bacterial pneumonia”,Cefoperazone sodium sulbactam sodium,Meropenem were given successively,the effect is not good,the relevant examination did not obtain sufficient etiological evidence,the metagenomic next-generation sequencing technology and pathological examination were performed,and the results indicated pulmonary infection of aspergillus,the antibiotic was changed to Voriconazole,and the patient was discharged after treatment.The possibility of fungal infection should be considered in patients with pulmonary infection who are not well treated by conventional antibiotics,if the pathogenic bacteria cannot be identified by routine examination,the diagnostic value of metagenomic next-generation sequencing technology should be emphasized.