摘要
目的探索宏基因组测序(mNGS)在鹦鹉热衣原体肺部感染诊断中的应用,为该病的诊断和治疗提供参考。方法采用mNGS对2019年12月—2020年12月复旦大学附属华山医院101例肺部感染患者的呼吸道标本进行测序,收集鹦鹉热衣原体阳性患者的临床资料;以“鹦鹉热”和“测序”为检索词检索知网数据库、万方数据库及维普数据库,以“psittac”和“next generation sequencing”为检索词检索PubMed数据库,检索年限不限,检索出经mNGS诊断鹦鹉热衣原体感染23例,并结合本研究检出鹦鹉热衣原体的病例进行分析。结果采用mNGS检测101例肺部感染患者的呼吸道标本,4例检出鹦鹉热衣原体序列。综合文献报道和该院4例鹦鹉热衣原体肺炎共27例,时间跨度从2019—2020年。临床表现主要为发热(100%)、咳嗽(63.0%)、咯痰(55.6%)。肺部CT主要表现为实变(13/27,48.1%)和胸腔积液(11/27,40.7%),14例(51.9%)病变仅累及单个肺叶。在诊断前6例(22.2%)治疗未覆盖非典型病原体,诊断后10例(37.0%)应用单药治疗,以多西环素或莫西沙星最为常用。鹦鹉热衣原体肺炎预后较好,26例(96.3%)患者在有效治疗后好转。结论mNGS技术已成为临床上诊断鹦鹉热衣原体主要的检出方法之一。四环素类或氟喹诺酮类治疗该微生物所致感染可取得较好疗效。
Objective To explore the application of metagenomic next-generation sequencing(mNGS)in the diagnosis of Chlamydia psittaci pulmonary infection,so as to provide reference for the diagnosis and treatment of this disease.Methods The respiratory tract specimens were collected from 101 patients with pulmonary infection in Huashan Hospital,Fudan University from December 2019 to December 2020.The samples were analyzed by mNGS technique.CNKI,Wanfang,and VIP databases were retrieved with"parrot fever"and"sequencing"as the search terms.PubMed database was retrieved with"psittac"and"next generation sequencing"as search term.The clinical data of Chlamydia psittaci-positive patients were collected appropriately.The retrieval period is unlimited.A total of 23 cases of Chlamydia psittaci pulmonary infection were diagnosed by metagenomic sequencing.Results In this study,respiratory specimens of 101 patients with pulmonary infection were detected by mNGS.Chlamydia psittaci sequence was detected in 4 cases.A total of 27 cases(including 4 recent cases in this paper)of pneumonia due to Chlamydia psittaci were reported from 2019 to 2020.The main clinical manifestations were fever(100%),cough(63.0%),and productive cough(55.6%).The findings on lung CT images included consolidation(13/27,48.1%)and pleural effusion(11/27,40.7%).Only a single lobe was involved in 14 patients(51.9%).Before diagnosis,antimicrobial regimen did not cover atypical pathogens in 6 patients(22.2%).After diagnosis,10 patients(37.0%)received monotherapy,with doxycycline or moxifloxacin being the most commonly used.The outcome of Chlamydia psittaci pneumonia was good.Overall,26 patients(96.3%)improved after effective treatment.Conclusions mNGS has become one of the most important method for clinical diagnosis of psittacosis.Tetracyclines and fluoroquinolones are effective in treating pneumonia caused by Chlamydia psittaci.
作者
陈欣
刘霜
赵旭
毕颖敏
巨默涵
袁瑾懿
徐晓刚
CHEN Xin;LIU Shuang;ZHAO Xu;Bi Yingmin;JU Mohan;YUAN Jinyi;XU Xiaogang(Institute of Antibiotics,Huashan Hospital,Fudan University,Key Laboratory of Clinical Pharmacology of Antibiotics,National Health Commission,Shanghai 200040,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2021年第6期680-687,共8页
Chinese Journal of Infection and Chemotherapy
基金
上海市科学技术委员会科研项目(18411950601)。
关键词
鹦鹉热
宏基因组测序
衣原体
肺部感染
诊断
psittacosis
metagenomic next-generation sequencing
Chlamydia
pulmonary infection
diagnosis
