摘要
目的:探讨宏基因组二代测序(mNGS)技术诊断肺脓肿病原的价值。方法:回顾性分析2019年8月至2021年8月温州医科大学附属第二医院育英儿童医院儿童呼吸科住院的4例肺脓肿患儿的临床资料和mNGS结果,并对相关文献进行复习。结果:4例患儿均为男性,年龄2月龄至11岁,有咳嗽、发热,发热持续时间10.5 d(6~17 d),其中例4伴呼吸困难、胸痛。4例均经胸部CT诊断为肺脓肿,例4为两侧肺脓肿。例1-3支气管肺泡灌洗液(BALF)mNGS分别检出肺炎链球菌、金黄色葡萄球菌、普雷沃菌,例4外周血mNGS检出约翰逊不动杆菌和人葡萄球菌。例1 BALF培养出肺炎链球菌,余3例均阴性。患儿经静脉抗菌药物治疗平均11.75 d(9~14 d)后病情好转,出院后口服抗菌药物序贯治疗,门诊随访8~12周,复查影像学显示肺脓肿吸收完全。共检索到7篇成人应用mNGS诊断肺脓肿病原的文献,未检索到儿童相关文献。结论:mNGS因其独特的技术优势,敏感性高,并能检出厌氧菌及罕见病原,可为儿童肺脓肿病原诊断提供新的手段,从而指导临床抗菌药物治疗。
Objective:To explore the application value of mNGS in the diagnosis of causative pathogens of lung abscesses.Methods:The clinical data and mNGS results of 4 children with lung abscess treated at the respiratory department of our hospital from August 2019 to August 2021 were retrospectively analyzed,and the relevant literature was reviewed.Results:All 4 cases were male,with onset age ranging from 2 month to 11 years presented with symptoms such as cough and fever,with the mean fever duration being 10.5(range 6-17 d)d;P4 also had dyspnea and chest pain.All 4 cases of lung abscess were diagnosed using chest CT,and P4 had two pulmonary abscesses.The mNGS analysis identified Streptococcus pneumoniae,Staphylococcus aureus,Prevotella respectively in P1-3(BALF),and Acinetobacter Johnson and Staphylococcus hominis in P4(blood).Only P1(BALF)had bacterial cultures positive for Streptococcus pneumoniae,and the other three patients were negative.All patients improved after intravenous antibiotic therapy with the mean duration being 11.75(ranging 9-14 d)d.They received oral antibiotic therapy(sequential)after discharge.They were followed-up 8-12 weeks,and their chest imaging was normal.Seven articles on the diagnosis of adult lung abscess pathogens by mNGS were retrieved.However,Literature search identified no related literature in pediatric cases or study.Conclusion:With its unique technical advantages,high sensitivity and the ability to detect anaerobic bacteria and rare pathogens,mNGS can provide new means for the diagnosis of causative pathogens of pediatric lung abscesses,which will guide the treatment of clinical antibacterial drugs.
作者
梁春婵
乐伊莎
李海燕
徐昌富
余刚
温顺航
林立
张海邻
董琳
LIANG Chunchan;LE Yisha;LI Haiyan;XU Changfu;YU Gang;WEN Shunhang;LIN Li;ZHANG Hailin;DONG Lin(Department of Pediatric Respiratory Medicine,the Second Affiliated Hospital&Yuying Children’s Hospital of Wenzhou Medical University,Wenzhou 325027,China)
出处
《温州医科大学学报》
CAS
2023年第3期233-239,共7页
Journal of Wenzhou Medical University
关键词
肺脓肿
病原
儿童
宏基因组二代测序
厌氧菌
lung abscess
pathogen
children
metagenomic next-generation sequencing
anaerobic bacteria
