肺泡灌洗液宏基因测序诊断儿童肺放线菌感染一例

儿童肺放线菌感染很罕见,且临床症状不典型,仅凭影像学表现易误诊为真菌、结核、肿瘤等。该文报道了1例儿童肺放线菌感染病例的诊治经过：7岁男性患儿,临床表现为发热、咳嗽,血常规提示白细胞及CRP明显升高,肺部CT提示肺部感染、待排除真菌等特殊菌群感染,常规抗感染治疗1周后肺部影像学无明显变化,行纤维支气管镜冲洗并取肺泡灌洗液进行宏基因测序后提示为放线菌感染,确诊后予静脉大剂量青霉素治疗,出院后予阿莫西林克拉维酸钾口服近2个月后复查CT明显好转。该例诊治过程提示,肺泡灌洗液宏基因测序有助于儿童肺放线菌感染的早期诊断,大剂量足疗程的青霉素可获得较好的疗效。

Application of metagenomic sequencing from alveolar lavage fluid in diagnosis of pediatric pulmonary actinomycete infection: a case report

Pediatric actinomycete infection is extremely rare without typical clinical symptoms. It is easily misdiagnosed as fungi, tuberculosis and tumors based on imaging findings. In this article, the diagnosis and treatment of a child with pulmonary actinomycete infection were reported. A 7-year-old boy presented with fever and cough. Routine blood test showed significant elevation in the white blood cells and C-reactive protein. CT scan of the lung suggested lung infection. The possibility of other special floral infection, such as fungus, should be excluded. After 1-week routine anti-infection treatment, no significant changes were detected in the imaging findings of the lung. Bronchoscopy was performed to obtain the alveolar lavage fluid for subsequent metagenomic sequencing, which prompted actinomycete infection. After the diagnosis was confirmed, he was administered with intravenous high-dose penicillin. After discharge, amoxicillin/clavulanate potassium was orally given for nearly two months. CT scan revealed significant improvement. The diagnosis and treatment of this case indicate that metagenomic sequencing from alveolar lavage fluids contributes to early diagnosis of pediatric pulmonary actinomycete infection. Full-course of high-dose penicillin can achieve high clinical efficacy.