宏基因二代测序技术在异基因造血干细胞移植后结核分枝杆菌感染中的应用

目的:探讨宏基因二代测序(metagenomic next-generation sequencing, mNGS)技术在异基因造血干细胞移植后结核分枝杆菌(mycobacterium tuberculosis, MTB)感染中的应用。方法:收集2018年1月至2020年5月采用mNGS诊断的11例异基因造血干细胞移植后MTB感染患者的临床资料,回顾性分析患者的临床特征及治疗转归。结果:11例患者中男6例,女5例;中位年龄45(28～56)岁;结核类型主要为肺结核(9例,81.8%),另外结核性脑膜炎和结核菌血症各1例;移植后并发MTB感染的中位时间为4.1(1.1～12.1)个月。临床表现：以发热和呼吸道症状最常见,其中发热7例,呼吸道症状8例,1例结核性脑膜炎患者表现为发热、头痛和癫痫。实验室检查：11例患者中3例(27.3%)涂片抗酸染色阳性(2例肺泡灌洗液,1例脑脊液);9例(81.8%)外周血T-SPOT阳性;5例(45.5%)Xpert阳性(4例肺泡灌洗液,1例脑脊液);1例(9.1%)外周血MTB-PCR阳性。通过mNGS均检测出MTB序列数(1～154)。影像学表现：肺...     

宏基因组二代测序辅助诊断鹦鹉热一例并文献复习

目的:探讨鹦鹉热的临床特征、流行病学特点、诊治及预后。方法:回顾性分析山东省千佛山医院呼吸与危重症医学科收治的1例鹦鹉热衣原体肺炎患者,对其诊治过程进行分析。以“Psittacosis”为检索词检索PubMed数据库,以“鹦鹉热”为检索词检索万方数据库、维普数据库及中国知网,对相关文献进行分析。结果:患者,男性,52岁,因“发热、咳嗽20 d”入院,既往有高血压病史。患者于院外先后经过莫西沙星和头孢哌酮钠舒巴坦钠抗感染治疗,但病情未见改善。转入我科后,通过肺泡灌洗液宏基因组二代测序(metagenomic next-generation sequencing, mNGS)检出鹦鹉热衣原体,确诊为鹦鹉热衣原体肺炎。经左氧氟沙星联合米诺环素治疗后好转出院。通过回顾文献发现,鹦鹉热是一种人畜共患疾病,可累及全身多系统,其中呼吸系统受累最为常见。此病可在人际间传播。宏基因组高通量测序技术相较于血清学、病原体分离培养、聚合酶链反应(polymerase chain reaction, PCR)等传统检测手段具有优越性。治疗首选四环素类药物,疗程为2～3周。该病的预后较好,整体病亡率约为1%。结论...     

宏基因组二代测序诊断惠普尔养障体重症肺炎一例报道并文献复习

惠普尔养障体（TW）重症肺炎是由TW感染引起的罕见病，传统检测方法不易获得其病原学证据，误诊率极高，故其早期诊断与治疗仍面临巨大挑战。宏基因二代测序（mNGS）可检测到传统检测手段无法检测到的罕见病原体，使得TW检出率不断提高。本文报道1例支气管肺泡灌洗液mNGS诊断为TW感染的重症肺炎患者，给予头孢曲松联合复方磺胺甲噁唑治疗，患者病情好转。     

宏基因组二代测序在间质性肺病伴感染患者中的应用

目的:探讨宏基因组二代测序(mNGS)在间质性肺病(ILD)伴肺部感染患者中的初步应用。方法:本研究为病例对照研究。采用单纯随机抽样法,选取2018年1月至2019年8月南京大学医学院附属鼓楼医院呼吸与危重症医学科住院、诊断为ILD伴感染患者61例为研究对象。按照是否进行mNGS检测,分为mNGS组( n＝...     

宏基因组二代测序辅助诊断鹦鹉热衣原体肺炎一例

<正>鹦鹉热衣原体作为一种革兰氏阴性、胞内寄生的病原体,通常在鹦鹉及鸽子中被发现。由于鹦鹉热的低发病率及无特异性的临床表现,其发生易被忽视。而且目前所存在的传统检测方法检出鹦鹉热衣原体病原体较为困难,然而宏基因组二代测序(metagenomic next-generation sequencing, mNGS)作为一种新型宏基因组二代测序方法,具有快速、准确、全面检测的优势。     

宏基因二代测序技术在肺部阴影发热病例诊断中的应用价值

目的 探讨支气管肺泡灌洗液(bronchoalveolar lavage fluid, BALF)病原宏基因二代测序(metagenomic next-generation sequencing, mNGS)技术在肺部阴影发热病例诊断中的价值。方法 回顾性分析我科收治的94例病例,均收集BALF同时行病原mNGS及传统检测(微生物培养+涂片镜检),比较两种方法诊断效能,并分析mNGS结果的影响因素。结果 以最终诊断为准,mNGS与传统检测比较：病原阳性率76.6%vs 19.1%、灵敏度83.5%vs 20.3%、阴性预测值40.9%vs 17.1%、诊断符合率79.8%vs 30.9%、混合感染检出率45.6%vs 7.6%,mNGS组明显优于传统组(P<0.05);且mNGS检出病原种类、数量及时间有明显优势。经二元Logistic分析基础疾病数量、发热可能是mNGS阳性结果的影响因素;检测公司及抗生素使用时间影响较小。结论 与传统检测相比,BALF的病原mNGS检测高效快速,有助于肺部阴影发热病例诊断和鉴别诊断。     

应用宏基因组二代测序方法确诊的Q热心内膜炎一例

Q热心内膜炎的致病菌为贝纳特柯克斯体,其存在临床诊断困难且治疗疗程长的问题,目前血清学抗体滴度检测仍是Q热心内膜炎主要诊疗手段。本文报道1例应用宏基因组二代测序方法协助确诊病例,但在如何精确治疗时间,评价治疗效果方面仍存在困惑,期待更多证据为这类患者制定更为精确的治疗方案。     

基于宏基因组的二代测序技术在重症肺炎患者病原体快速检测中的应用价值探讨

目的探讨基于宏基因组的二代测序技术(mNGS)在重症肺炎患者病原学检测中的应用价值。方法纳入2018-07~2019-05收治的重症肺炎患者26例,比较mNGS与传统检测方法对病原菌的诊断效能,同时评价抗生素暴露对检出率的影响。结果mNGS检出病原菌的阳性率为92.3%,高于传统培养方法的42.3%,差异有统计学意义(P<0.05)。在使用抗生素的前提下,mNGS的阳性率(91.3%)显著高于传统方法(43.5%),差异有统计学意义(P<0.05)。结论mNGS对病原菌鉴定具有较高的灵敏度,而且使用抗生素对mNGS检测结果影响小,对感染患者的诊治及疗效有着重要的临床应用价值。     

宏基因组二代测序技术在2型糖尿病合并肺部感染患者中的临床应用

目的 比较宏基因组二代测序技术(metagenomic Next-Generation Sequencing, mNGS)与传统病原学诊断方法对2型糖尿病患者肺部感染病原学诊断的优劣,为临床诊治提供参考依据。方法 对阜阳市人民医院在2021年11月至2023年3月就诊的103例2型糖尿病合并肺部感染患者进行回顾性分析,均接受传统培养及mNGS检测,比较两种不同检测方法对病原体检测的阳性率、病原学分布及检测结果的一致性;比较两种不同检测方法的敏感度、诊断效能;比较不同分组患者mNGS阳性检出率。结果 mNGS检测对肺部感染病原检出阳性率、诊断敏感度显著高于传统检测方法(81.55%vs 42.72%,P<0.001);(92.68%vs 51.21%,P<0.001),但是两者一致性较差(Kappa=0.179<0.4)。在各个亚组mNGS检出阳性率的比较中,合并肺基础疾病组检出阳性率更高(93.02%vs 73.33%,P<0.05)。结论 mNGS检测可提高2型糖尿病合并肺部感染患者病原体的检出率,尤其是在真菌、病毒、特殊病原体方面。     

宏基因组二代测序技术对髋/膝关节结核的诊断价值

目的:评价宏基因组二代测序(metagenomic next generation sequencing, mNGS)技术对髋/膝关节结核的诊断价值。方法:采用回顾性研究方法,收集2019年6月至2021年6月河北省胸科医院收治的34例髋/膝关节感染患者资料,按照病原菌种类分为关节结核组(16例)和非结核感染性疾病组(18例),分别对所有患者感染病灶组织样本进行常规细菌学培养和分枝杆菌培养(MGIT 960培养)、结核分枝杆菌(MTB)-DNA扩增检测及mNGS检测。以临床诊断为参照标准,比较分枝杆菌培养、MTB-DNA扩增和mNGS检测对髋/膝关节结核的诊断效能。结果:mNGS对非结核感染性疾病组中病原体的检出率为100.0%(18/18);对髋/膝关节结核的阳性检出率为93.8%(15/16),明显高于MTB-DNA扩增检测[50.0%(8/16)]和MGIT 960培养[25.0%(4/16)],差异均有统计学意义(χ²=7.575,P=0.015;χ²=15.676,P=0.000)。以临床诊断为参照标准,mNGS诊断髋/膝关节结核的...     

宏基因组学测序诊断曼氏裂头蚴病1例

患者于2000年无明显诱因发现下腹部游走性包块,20年来多次就诊,未明确病因。2020年8月11日发现包块游走于左侧腋前,微创手术取出不完整白色虫体3段,用宏基因组学测序鉴定虫体,明确诊断为曼氏裂头蚴病。2021年10月21日经手术取出完整虫体,患者康复出院;随访患者身体状况良好,全身未发现新包块。     

Infections caused by Drechslera species: case report and review of the literature

Organisms belonging to Drechslera species are rare causes of human infection and are considered opportunistic pathogens. Only 10 cases of human infection with these organisms have been reported in the literature; an additional case--that of a healthy young woman with chronic pansinusitis due to Drechslera spicifera causing nasal obstruction and erosion of bone--is described herein. This case was managed successfully by means of surgical debridement and therapy with amphotericin B and ketoconazole. A review of the literature suggests that infections caused by Drechslera species can in fact occur in a healthy host. Involvement of the paranasal sinuses and the central nervous system is common and potentially life-threatening. Appropriate therapy consists of the administration of amphotericin B, either alone or in combination with other antifungal agents, and surgical debridement when indicated.     

Ileocecal endometriosis and a diagnosis dilemma: A case report and literature review

Bowel endometriosis affects between 3.8% and 37% of women with endometriosis. The evaluation of symptoms and clinical examination are inadequate for an accurate diagnosis of intestinal endometriosis. We describe the case of a 41-year-old woman who presented to our hospital because of six months of recurrent abdominal pain, vomiting and diarrhea, without previous history of bowel disease. Physical examination revealed a palpable 3 cm × 5 cm mass in the right lower quadrant abdomen. Laboratory tests showed slightly elevated levels of CA19-9 and CA125. Small bowel computer tomography scanning revealed an ileocecal mass with bowel wall thickening and luminal narrowing. Small bowel endoscopy identified a deep longitudinal ulcer and mucosal edema in the distal ileum. All these findings supported the diagnosis of Crohn’s disease. The patient underwent a laparotomy, which identified a 5 cm × 5 cm ileocecal mass with severe mucosal edema and luminal stricture in the distal ileum. Histopathological examination confirmed a diagnosis of ileocecal endometriosis without other areas involved. After oneyear follow-up, there was no recurrence of the symptoms.     

Radiological diagnosis of duodenocaval fistula:A case report and literature review

Duodenocaval fistula(DCF) is an uncommon but lethal clinical entity.The high mortality has been attributed to the difficulty of diagnosis before attempts at definitive therapy.In this case report,we describe a patient with a series of computed tomography(CT) examinations over a 2-mo period in hospital.A low-density air bubble appeared in the inferior vena cava(IVC) on the second day in hospital and became clear on day 19,and gradually enlarged.Magnetic resonance imaging(MRI) also clearly demonstrated a high...     

Sezary综合征1例并文献复习

目的:通过报告1例sezary综合征以及文献复习提高对此病的认识。方法:报告1例sezary综合征,并对国内文献进行总结分析。结果:共26例sezary综合征患者,男性23例占88.5%,中位年龄59.5岁,主要表现为全身红皮病,伴有瘙痒,可出现淋巴结肿大、肝脾肿大。实验室检查发现白细胞升高,外周血中可找到sez-ary细胞。皮肤或淋巴结活检可发现sezary细胞。部分患者经以激素为主的治疗后获得缓解。结论:sezary综合征是一罕见的淋巴瘤,对此病的认识还需提高,国内尚需加强对细胞免疫分型和分子生物学的检测。     

Traumatic hemobilia: a case report and literature review

Traumatic hemobilia consists of hemorrhage into the biliary tract as a result of abdominal trauma. The classical triad of biliary colic, jaundice and upper gastrointestinal bleeding is not a constant finding, and clinically silent hemobilia has been reported. The treatment of choice is selective embolization, but spontaneous cessation of bleeding can occur, especially in mild forms. We report a case of occult traumatic hemobilia in which the diagnosis was suggested by transitory changes in ultrasonography and hepatic biochemistry.     

Pre-operative diagnosis of Meckel's diverticulum: report of a case and review of literature.

Meckel's diverticulum represents a patent omphalomesenteric duct at its junction with the ileum. Although it is a common anomaly, it is often a surgical surprise as the preoperative diagnosis is seldom established. We present an unusual case where the constellation of imaging findings was so typical that we could suggest this diagnosis prospectively and it was subsequently confirmed surgically.