呼吸道样本中检出惠普尔养障体病例诊断的华西建议

Diagnosis for cases with Tropheryma whipplei detected from respiratory samples:West China suggestions

惠普尔病是一种主要累及胃肠道的多系统性疾病,其病原体为惠普尔养障体。文献报道惠普尔养障体也可导致肺部感染,而检出惠普尔养障体依赖于核酸检测。随着二代测序技术的应用,呼吸道样本中检出惠普尔养障体的病例日益增多,但这类病例缺乏公认的诊断标准。因此,该文基于临床经验和诊断思维并参考国际侵袭性真菌感染分级诊断标准提出了呼吸道样本中检出惠普尔养障体病例的分级判断体系,包括5个级别(确诊、拟诊、疑诊、拟排、排除)。对四川大学华西医院呼吸道样本中通过二代测序技术检出惠普尔养障体的病例进行基于分级判断体系的分析发现:共有26例检出病例,可分为拟诊6例、疑诊9例、拟排8例和排除3例。并据此提出了样本采集及检验、患者管理方面的具体建议,及进一步研究方向。此建议是基于四川大学华西医院现有病例的初步建议,还需要更多临床病例和进一步临床研究予以验证、修改、优化,甚至重构。

Whipple’s disease is a multisystemic disease caused by Tropheryma(T.)whipplei that primarily affects the gastrointestinal tract.In literature,T.whipplei can also cause pulmonary infections.The detection of T.whipplei depends on nucleic acid-based test.With the application of next-generation sequencing(NGS),cases with T.whipplei detected from respiratory tract samples by NGS are increasingly found but there is lack of recognized diagnostic criteria for these cases.Within the context,we propose a grading diagnostic scheme for the situation that T.whipplei is detected from respiratory tract samples,based on clinical experience and diagnostic thinking,and referring to the international classifications of invasive fungal infections.The scheme comprises five levels:confirmed,probable,possible,impossible,and excluded.There were 26 such cases from West China Hospital of Sichuan University and we used our diagnostic scheme to define probable in 6 cases,possible in 9 cases,impossible in 8 cases,and excluded in 3 cases.Based on this,we also propose specific suggestions for sample collection and testing,patient management,and further research directions.These recommendations are preliminary based on the existing cases from West China Hospital of Sichuan University and therefore needs to be verified,modified,optimized,and even reconstructed when more clinical evidence and further clinical studies become available.