经宏基因组二代测序诊断立克次体病3例  

Three Cases of Rickettsiosis Diagnosed by Metagenomic Next-Generation Sequencing

作　　者：张兰[1] 袁兰 袁义美 王震[1] 范雪娟 崔宁[1] 袁春[1] ZHANG Lan;YUAN Lan;YUAN Yimei;WANG Zhen;FAN Xuejuan;CUI Ning;YUAN Chun(Department of Infectious Diseases,No.990 Hospital of the Chinese People’s Liberation Army Joint Logistic Support Force,Xinyang 464000,China)

机构地区：[1]中国人民解放军联勤保障部队第九九〇医院感染科,河南信阳464000

出　　处：《河南医学研究》2022年第1期102-105,共4页Henan Medical Research

基　　金：国家“十三五”重大专项课题(2017ZX10103002-002-005)。

摘　　要：目的探讨宏基因组二代测序(mNGS)在新发立克次体病诊断中的应用价值。方法回顾性分析2020年9月至2021年4月于中国人民解放军联勤保障部队第九九〇医院感染科住院疑诊为立克次体病并最终经mNGS检测技术确诊为立克次体病的3例患者的资料。结果3例患者中2例有明确蜱叮咬史,均急性起病,主要表现为发热伴皮疹、头痛、乏力、纳差、全身肌肉酸痛、关节痛等。3例患者外斐试验、布鲁菌病凝集试验、发热伴血小板减少综合征布尼亚病毒-RNA(SFTSV-RNA)及血培养均阴性,血液mNGS检测到Rickettsia argasii的核酸序列数为160~1739条,基因覆盖率为1.42%~9.79%。患者经多西环素治疗,48 h后体温明显下降,96 h恢复正常,病情恢复后痊愈出院。结论应用mNGS首次证明Rickettsia argasii这一新型立克次体具有致病作用,临床上应注意与发热伴血小板减少综合征(SFTS)鉴别。mNGS为新发立克次体病的研究提供了重要的手段。临床上高度怀疑立克次体病时,可及时采用多西环素进行经验治疗。Objective To investigate the application value of metagenomic next-generation sequencing(mNGS)in the diagnosis of emerging rickettsial disease.Methods A retrospective analysis was made on the data of 3 patients who were suspected to be rickettsia from September 2020 to April 2021 in the Department of Infectious Diseases of No.990 Hospital of the Chinese People’s Liberation Army Joint Logistic Support Force,and were finally diagnosed as rickettsia by mNGS detection technology.Results Two of the three patients had a clear history of tick bite,and all of them had acute onset.The main symptoms were fever with rash,headache,fatigue,poor appetite,muscle soreness,joint pain,etc.The Weil-Felix test,brucellosis agglutination test,severe fever with thrombocytopenia syndrome bunyavirus-RNA(SFTSV-RNA)and blood culture of 3 patients were all negative.The number of nucleic acid sequences of Rickettsia argasii was 160 to 1739 and the gene coverage rate was 1.42%to 9.79%.After 48 hours of treatment with doxycycline,the body temperature of the patients decreased significantly,and returned to normal 96 hours later.After recovery,they were discharged from hospital.Conclusion The application of mNGS proves for the first time that Rickettsia argasii,a new rickettsia,has pathogenic effect,and it should be distinguished from severe fever with thrombocytopenia syndrome(SFTS)clinically.mNGS provides an important means for the study of newly emerged rickettsial disease.When the rickettsial disease is highly suspected clinically,doxycycline can be used for empirical treatment in time.

关 键 词：立克次体 宏基因组二代测序 发热伴血小板减少综合征 多西环素 

分 类 号：R513[医药卫生—内科学]