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find Keyword "二代测序" 34 results
  • 鹦鹉热衣原体肺炎的临床诊疗特点

    目的 探讨鹦鹉热衣原体肺炎的临床诊疗特点。方法 收集2020年9月—2021年12月由苏州大学附属第一医院和附属独墅湖医院呼吸与危重症医学科收治的12例鹦鹉热衣原体肺炎患者的临床资料,进行总结分析。结果 12例患者均以高热、咳嗽为主要表现起病,9例患者接触过鹦鹉,3例接触过活禽。12例患者淋巴细胞计数均不同程度降低,2例患者白细胞、中性粒细胞和降钙素原明显升高;C反应蛋白、红细胞沉降率和D-二聚体均明显升高,而白蛋白水平明显降低,4例患者出现了低钾血症。1例重症患者合并了呼吸衰竭、心力衰竭、肝衰竭、肾衰竭及轻度精神症状。胸部CT均表现为单一肺叶或多肺叶炎症渗出和实变,5例合并有少量胸腔积液。患者初始经验性治疗效果均不理想,支气管肺泡灌洗液宏基因组二代测序技术检测诊断鹦鹉热衣原体肺炎后,及时调整以四环素类药物和(或)喹诺酮类抗生素为基础的治疗方案后病情均好转出院。结论鹦鹉热衣原体肺炎临床相对少见,临床表现以及常规检查很难与其他社区获得性肺炎鉴别,易导致误诊和漏诊,应引起临床医生的重视,宏基因组二代测序技术在鹦鹉热衣原体肺炎诊疗方面具有重要指导意义,值得临床应用和推广。

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  • 黄疸出血型钩端螺旋体病合并多器官功能障碍综合征一例

    Release date:2023-04-24 08:49 Export PDF Favorites Scan
  • Chlamydia psittaci pneumonia: a clinical analysis of 21 patients

    Objective To explore the clinical characteristics of Chlamydia psittaci pneumonia. Methods From January 2020 to March 2023, 21 cases of Psittacosis from the First Affiliated Hospital of Nanjing Medical University were diagnosed via metagenomic next-generation sequencing (mNGS). They were divided into a severe group (n=10) and a non-severe group (n=11) based on diagnostic criteria for severe pneumonia, and the clinical presentation, secondary examination, treatment, and prognosis of the two groups were analyzed retrospectively. Results Among the 21 patients, there were 11 males and 10 females, with a mean age of (51.7±11.6) years. All patients had an acute onset and 12 had a confirmed history of exposure to poultry. The onset of the disease occurred in the autumn and winter seasons in 18 patients. All the patients were suffering from high fevers. Other symptoms included coughing, phlegm, tightness in the chest and fatigue. Laboratory examinations showed that the levels of leukocytes, neutrophil counts, C-reactive protein, procalcitonin, aminotransferase, creatine kinase, lactic dehydrogenase, brain natriuretic peptide precursors and D-dimer were significantly higher in the severe group than those in the non-severe group. Chest CT scans revealed varying levels of consolidation and spot shadowing with peripheral exudate in all patients. The patients in the severe group were more likely to have bilateral lung involvement, bilateral pleural effusion, cavity and mediastinal lymph node enlargement. Eleven patients received tetracycline alone, three received laudanum alone, two received respiratory quinolones alone, and five received a combination of two drugs including tetracycline. Chest CT at clinical follow-up showed absorption of lung lesions. Conclusions Chlamydia psittaci pneumonia usually occurs in the fall and winter, and most patients have a history of contact with poultry. Clinical presentation and imaging are not specified. The technology of mNGS enables early diagnosis of the disease, and neutrophil lymphocyte ratio, neutrophil-lymphocyte ratio and lactic dehydrogenase levels help assess the risk of severe disease.

    Release date:2023-11-13 05:45 Export PDF Favorites Scan
  • 宏基因组二代测序辅助诊断军团菌病伴横纹肌溶解和急性肾损伤一例

    目的 加强临床医生对军团菌病多器官损害临床特点的认识,针对目前军团菌诊断的难点,重视宏基因组二代测序(metagenomic next-generation sequencing,mNGS)在本病诊断中的应用价值,以早期诊断与精准治疗,改善军团菌病患者的预后。方法 分析 1 例经 mNGS 确诊的嗜肺军团菌病患者的临床特点、治疗过程及预后。结果 患者男,61 岁,因“发热、咳嗽伴乏力 3 d”就诊。发病初期除呼吸道症状外,合并多系统症状。住院期间,在肺泡灌洗液及肺组织中,mNGS 检出嗜肺军团菌,结合临床特点诊断军团菌病。患者经有创呼吸、抗感染、血液透析、保肝等综合治疗后,最终顺利出院。结论 对于病程短,以肺炎表现为主伴多器官受累的疾病,尤其伴肌酸激酶显著升高者应警惕军团菌感染可能。对于病情危重且少痰或无痰的患者,在缺少其他检测方法(如军团菌尿抗原)的情况下,可行纤维支气管镜取肺泡灌洗液或经皮肺穿刺取肺组织进行mNGS检查,以早期明确病原体。军团菌肺炎伴发横纹肌溶解和急性肾损伤时,及早予以针对病因及并发症的综合治疗有助于改善患者预后。

    Release date:2022-10-27 10:51 Export PDF Favorites Scan
  • 非免疫缺陷患者确诊为纵隔黄曲霉脓肿一例报道并文献复习

    目的 总结分析纵隔曲霉病的临床特征,以提高临床医生对纵隔曲霉病的认识。方法 回顾性分析1例纵隔黄曲霉脓肿患者的临床资料、实验室检查、影像学检查、治疗方案及预后,并复习国内外相关文献。结果 患者男,68岁,其胸部CT示纵隔肿块,伴气管、右主支气管复杂狭窄,纤维支气管镜及经超声支气管镜针吸活检(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)及宏基因组二代测序(metagenomic next-generation sequencing,mNGS)诊断为纵隔黄曲霉脓肿。予伏立康唑及激素治疗后病情好转,4个月后随访患者病情稳定。以“纵隔曲霉病、纵隔脓肿”与“非免疫缺陷者”为关键词检索中国知网医学数据库和维普网数据库,国内尚无文献报道。使用“mediastinal aspergillosis”、“aspergillus mediastinitis”、“mediastinal aspergilloma”检索PubMed数据库中的英文文献,共检索到文献17篇,均为个案报道。结论 非免疫缺陷患者出现纵隔肿物时,需警惕曲霉感染的可能,早期及时的诊断及治疗尤为重要。EBUS-TBNA联合mNGS可作为纵隔曲霉病的诊断方法之一。伏立康唑联合小剂量激素(0.5 mg/kg)治疗方案,可能为纵隔曲霉病提供新的治疗思路。

    Release date:2024-06-21 05:13 Export PDF Favorites Scan
  • Application of metagenomic next-generation sequencing in diagnosis and treatment of severe infection of hematological disorder

    Objective To explore the clinical value of metagenomic next-generation sequencing (mNGS) in the diagnosis and treatment of severe and complex infection of malignant hematological disorder. Methods The mNGS test results, traditional etiology test results and general clinical data of inpatients with malignant hematological disorder in the Department of Hematology, the Affiliated Hospital of Southwest Medical University between June 2020 and February 2022 were retrospectively analyzed. To explore the clinical application value of mNGS in the diagnosis and treatment of severe complicated infection of hematological disorder. Results A total of 21 patients were included. The samples included 18 peripheral blood samples, 2 pleural fluid samples and 1 alveolar lavage fluid sample. In the included patients, through mNGS, pathogenic bacteria were directly detected in 17 patients, including 8 fungi, 9 bacteria and 10 viruses, of which 9 were mixed infections. The positive rate (81.0% vs. 33.3%, P=0.002), sensitivity (85.7% vs. 30.0%), granulocytopenia (9 vs. 3 cases, P=0.031) and the types of pathogen (Z=−3.416, P=0.001) detected by mNGS were all higher than those by traditional method. The infection control of 17 patients improved in varying degrees after adjusting the treatment plan according to the test results. ConclusionsmNGS has significantly higher detection rate and sensitivity for bacteria, fungi, viruses and mixed infections. Compared with the traditional method, mNGS has more efficient characteristics. Its clinical application can further improve the diagnosis and treatment efficiency of severe complicated infection of malignant hematological disorder, and thus improve the survival rate of patients.

    Release date:2022-09-30 08:46 Export PDF Favorites Scan
  • Analysis of sputum flora in patients with acute exacerbation of chronic obstructive pulmonary disease basing on metagenomic next generation sequencing

    Objective To analyze the difference of sputum flora between acute exacerbation and stable chronic obstructive pulmonary disease (COPD) patients basing on metagenomic next generation sequencing (mNGS), and its relationship with clinical indicators. The role of sputum flora of COPD patients in unexplained deterioration was explored, so as to find a targeted treatment plan. Methods From December 2021 to June 2022, 54 COPD patients who had a history of smoking were recruited, including 25 patients in stable COPD (SCOPD group) and 29 patients in acute exacerbation (AECOPD group). The sputum was collected and sequenced by mNGS, and the difference of sputum flora between the two groups was compared. Results Compared with SCOPD group, the evenness of sputum flora (Shannon index) in AECOPD group decreased significantly (P=0.019, Mann-Whitney U test). At the phylum level, the relative abundance of Fusobacteria in AECOPD group was significantly lower than that in SCOPD group (Z=–2.669, P=0.008). At genus level, compared with SCOPD group, the relative abundance of Fusobacterium and Haemophilus in AECOPD group decreased significantly (Z=–3.062, P=0.002; Z=–2.143, P=0.032), and the relative abundance of Granulicatella increased significantly (Z=–2.186, P=0.029). At species level, the relative abundance of sputum Haemophilus parainfluenzae, Moraxella catarrhalis and Haemophilus influenzae in AECOPD group was significantly lower than that in SCOPD group (Z=–2.230, P=0.026; Z=–2.125, P=0.034; Z=–2.099, P=0.036). At the time of acute exacerbation of COPD, the relative abundance of Gemella in sputum was positively correlated with forced expiratory volume in first second/forced vital capacity (FEV1/FVC) and body mass index (r=0.476, P=0.009; r=0.427, P=0.021), which was negatively correlated with nutrition risk screening 2002 (r=–0.570, P=0.001). The relative abundance of Neisseria and Neisseria subflava was negatively correlated with GOLD grade (r=–0.428, P=0.020; r=–0.455, P=0.013). The relative abundance of Rothia aeria was posotively correlated with C-reactive peotein (r=0.388, P=0.038). Conclusions There are significant differences of sputum flora in phylum, genus and species level between stable and acute exacerbation COPD patients. The evenness of sputum flora in COPD patients in acute exacerbation is significantly lower than that in patients in stable stage. Fusobacteria, Fusobacterium, Gemella and Nesseria (Neisseria subflava) may play a beneficial role in COPD, while Rothia aeria may be associated with COPD exacerbation.

    Release date:2023-09-02 08:56 Export PDF Favorites Scan
  • 头颅影像结合脑脊液二代测序诊断咽峡炎链球菌群致硬膜下积脓一例

    Release date:2022-09-30 08:46 Export PDF Favorites Scan
  • Diagnosis and treatment of pulmonary infection with rare pathogen

    In recent years, with the wide application of metagenomics next-generation sequencing, more and more rare pathogens have been detected in our clinical work, including non-tuberculous Mycobacterium, Corynebacterium, Fusarium, Cryptococcus pneumoniae, human herpes virus, torque teno virus, parvovirus, Tropheryma whipplei, Bartonella, Chlamydia psittaci, etc. It is difficult to determine whether these rare pathogens are clinically significant and need treatment. This article puts forward some suggestions and discussions on the diagnosis and treatment of pulmonary infections with some rare pathogens.

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  • 变应性支气管肺曲霉病合并肺诺卡菌感染一例并文献复习

    目的提高对变应性支气管肺曲霉病(allergic bronchopulmonary aspergillosis,ABPA)合并诺卡菌感染的认识。方法回顾我科诊断的1例ABPA合并诺卡菌感染的临床资料,结合文献复习ABPA和诺卡菌病的宿主特征、临床表现、影像特点等。结果患者男,79岁,退休工人,咳嗽、咳痰、喘息、胸闷20余年,有影像资料记录至少漏诊ABPA 6年。血嗜酸性粒细胞计数和比例升高,血清总IgE升高,胸部CT表现为中心型支气管扩张和浸润影,诱导痰中性粒细胞和嗜酸性粒细胞比例升高,肺泡灌洗液淋巴细胞和嗜酸性粒细胞比例升高,灌洗液mNGS、灌洗液和痰培养证实有诺卡菌和烟曲霉。给予糖皮质激素、伏立康唑、伊曲康唑和复方磺胺甲噁唑治疗,短期内临床症状减轻,血嗜酸性粒细胞下降,肺部影像有所好转,但血清总IgE无明显下降。复习文献,有3例个案报道。其中,2例ABPA治疗中继发诺卡菌感染,与应用糖皮质激素治疗引起免疫抑制有关,1例确诊ABPA前应用多种抗生素引起诺卡菌“二重感染”。结论ABPA和诺卡菌病的免疫状态不同,前者引起的支气管扩张可能是合并诺卡菌感染的危险因素。

    Release date:2023-04-28 02:38 Export PDF Favorites Scan
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