摘要
目的分析1例隐球菌培养阴性,宏基因组测序检出新型隐球菌序列,隐球菌抗原检测阳性的自身免疫性脑炎并发肺隐球菌感染病例的诊治过程,旨在为临床诊断和治疗肺隐球菌病提供帮助。方法分析1例血清隐球菌荚膜多糖抗原阳性、自身免疫性脑炎患者的临床资料,分别采用常规检测、生化检测、微生物培养和气管镜肺泡灌洗液宏基因组二代测序(mNGS)等方法进行复查,明确肺炎感染类型,并结合文献对肺隐球菌病进行复习讨论。结果该例患者HIV检测阴性,痰液Xpert MTB/RIF结核分枝杆菌检测阴性;痰液、肺泡灌洗液细菌培养结果为正常菌群生长,隐球菌培养阴性;血培养阴性。脑脊液常规检测、生化检测、微生物培养结果均正常,隐球菌抗原阴性,墨汁染色未检出隐球菌;气管镜肺泡灌洗液mNGS结果提示新型隐球菌,序列数6,相对丰度46.15%,覆盖度0.0010%。口服氟康唑治疗3个月后患者肺部CT检查结果显示右肺下叶类圆形结节影伴空洞较之前缩小。结论临床工作中遇到免疫功能低下、且肺部影像学检查出空洞的患者,血清隐球菌荚膜多糖抗原和呼吸道标本mNGS联合检测可以有效辅助临床对肺隐球菌病的诊疗。
Objective To analyze the diagnosis and treatment of a case of autoimmune encephalitis complicated by pulmonary cryptococcal infection with negative cryptococcal culture,detection of cryptococcus neoformans sequences by metagenomics next-generation sequencing(mNGS),and positive detection of cryptococcal antigens.Methods The clinical data of a patient with positive serum cryptococcal capsular polysaccharide antigen and autoimmune encephalitis were analyzed.Routine tests,biochemical tests,microbial culture and bronchoscopic alveolar lavage fluid(BALF)by mNGS were adopted to clarify the type of pneumonia infection.Pulmonary cryptococcosis was reviewed and discussed combining with relevant literatures.Results The patient was negative in HIV testing and sputum Xpert MTB/RIF assay for Mycobacterium tuberculosis.Sputum and BALF bacterial culture results were normal flora growth and cryptococcal culture was negative.Blood culture result was negative.The routine tests,biochemical tests,and microbiologic cultures of cerebrospinal fluid showed normal results.Cryptococcal antigen of cerebrospinal fluid was negative and no cryptococcus was detected by ink staining.BALF by mNGS suggested cryptococcus neoformans with reads 6,relative abundance of 46.15%and coverage of 0.0010%.After 3 months of oral fluconazole treatment,the patient′s lung CT showed a classically round nodular shadow with a cavity in the lower lobe of the right lung that was smaller than before.Conclusion The combination of serum cryptococcal polysaccharide antigen and mNGS analysis of respiratory specimens in immunocompromised patients with cavities detected on lung imaging can be effective for clinical diagnosis and treatment of pulmonary cryptococcosis.
作者
姚怡婷
潘允琪
曾健
徐伟红
YAO Yiting;PAN Yunqi;ZENG Jian;XU Weihong(Department of Laboratory Medicine,Tong Ren Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200336,China;Department of Respiratory Medicine,Tong Ren Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200336,China)
出处
《检验医学与临床》
CAS
2024年第9期1317-1320,共4页
Laboratory Medicine and Clinic
基金
上海市长宁区新发感染与免疫调控博士创新人才基地(RCJD2021B01)
肠道微生物与疾病交叉科创基地
上海交通大学同仁医院课题项目(TR2018T01)。
关键词
肺隐球菌病
自身免疫性脑炎
宏基因组二代测序
隐球菌荚膜多糖抗原
pulmonary cryptococcosis
autoimmune encephalitis
metagenomics next-generation sequencing
cryptococcal capsular polysaccharide antigen
