1例宏基因二代测序提示钩端螺旋体感染患者的实验室诊断

目的 对一不明原因发热伴呼吸困难患者进行实验室诊断,探讨钩端螺旋体实验室确诊的检测方法。方法 利用宏基因二代测序技术(mNGS)对一不明原因发热伴呼吸困难患者的肺泡灌洗液进行病原体分析,利用实时荧光定量PCR(Real-time PCR)、显微镜凝集试验(MAT)和传统培养方法对患者进行实验室确诊。结果 mNGS对不明原因发热伴呼吸困难患者的肺泡灌洗液进行病原体分析提示患者可能被问号钩端螺旋体感染,Real-time PCR和传统培养方法对患者的肺泡灌洗液、血液和尿液检测均为阴性,血清抗体检测(MAT法)致病性钩端螺旋体澳洲型滴度为1:800。结论 该患者确诊为致病性钩端螺旋体澳洲型感染,mNGS与实验室传统方法的有机结合有助于对不明原因发热伴呼吸困难患者实验室诊断,特别是对钩端螺旋体的实验室诊断具有重要意义。

Laboratory diagnosis in a patient suspected of Leptospira infection by metagenomic next-generation sequencing

To investigate the laboratory diagnosis of leptospirosis in a patient with fever and dyspnea of undetermined origin. Metagenomic next-generation sequencing(mNGS) was used to analyze the pathogens in the bronchoalveolar lavage fluid(BALF)of an patient with fever and dyspnea of undetermined origin, and the patient was confirmed by Real-time PCR, immunology methods and the conventional culture methods.The patient of fever and dyspnea of undetermined origin was suspected of leptospirosis infection by mNGS. The BALF, blood and urine samples were tested negative for leptospirosis by Real-time PCR and the conventional culture methods. The serum antibody titer was 1:800 of Leptospire australis by MAT.It is very great significance of the combination of mNGS and the traditional method of the laboratory diagnosis of leptospirosis in patient with fever and dyspnea of undetermined origin.