基于宏基因组二代测序的聚集性发热事件病原体鉴定  

Pathogen identification of a cluster of fever cases based on metagenome next-generation sequencing

作　　者：丁锡富 施国富 胡爱荣 练祥 DING Xi-fu;SHI Guo-fu;HU Ai-rong;LIAN Xiang(Xiangshan First People's Hospital Medical and Health Group,Ningbo,Zhejiang 315700,China;不详)

机构地区：[1]宁波市象山县第一人民医院医疗健康集团,浙江宁波315700 [2]中国科学院大学宁波华美医院(宁波市第二医院),宁波市肝病研究所,浙江宁波315010 [3]国科宁波生命与健康产业研究院,浙江宁波315010

出　　处：《中国卫生检验杂志》2022年第2期182-185,共4页Chinese Journal of Health Laboratory Technology

基　　金：浙江省宁波市共建医学重点学科项目(2016-S04);宁波市领军和拔尖人才工程项目(2015-165)。

摘　　要：目的探讨宏基因组二代测序(mNGS)在聚集性发热事件病原体鉴定中的作用。方法分析2020年4月25日本地区某学校某班级15例不明原因聚集性发热病例的临床特征及诊治。所有患者均给予常规病原学检测方法(细菌培养、抗原抗体检测、核酸检测等),并选择2例症状较重患者,行支气管肺泡灌洗液(BALF)宏基因组二代测序(mNGS)分析及细菌培养鉴定。结果15例患者均有发热,打喷嚏5例,外周血白细胞升高10例,胸部CT提示肺部斑片状高密度影改变2例。所有患者IgM抗体、IgG抗体、流感病毒核酸、呼吸道病原体抗体谱(肺炎支原体、衣原体、呼吸道合胞病毒、腺病毒、流感病毒和副流感病毒IgM抗体)、曲霉菌半乳甘露聚糖抗原检测(GM试验)、隐球菌乳胶凝集试验、全血细菌分离培养和鉴定结果均为阴性。BALF mNGS分析显示缓症链球菌基因组5个位点检测深度达100以上,3个位点达200以上,肺炎链球菌4个位点检测深度达100以上,但所有位点均未超过200。根据mNGS结果应用抗生素后,所有患者症状消失。BALF培养和鉴定亦为缓症链球菌。结论此次不明原因聚集性发热事件的病原体为缓症链球菌,mNGS在不明原因聚集性发热事件的积极应对中有一定的指导作用。Objective To explore the role of metagenomics next-generation sequencing(mNGS)in the identification of pathogens of cluster fever events.Methods The clinical characteristics,diagnosis and treatment of 15 cases with unexplained group fever in a class of a school in this region on April 25,2020 were analyzed.All patients were given routine etiological testing methods(bacterial culture,antigen and antibody testing,nucleic acid testing,etc.).And the bronchoalveolar lavage fluid(BALF)of two patients with severe symptoms was selected for next-generation sequencing(mNGS)analysis and identification.Results All the 15 patients had fever,five cases had sneezing,ten cases had elevated peripheral blood leukocytes.The chest CT showed patchy high-density shadow changes in 2 cases.The testing results of all patients were negative in serum nucleic acid of IgM antibody and IgG antibody of SARS-CoV-2,nucleic acid of influenza virus,respiratory pathogen antibody spectrum(IgM antibodies of Mycoplasma pneumoniae,chlamydia,respiratory syncytial virus,adenovirus,influenza virus and parainfluenza virus),aspergillus galactomannan(GM)antigen assay,cryptococcal latex agglutination assay,and isolation and identification of bacterial content in blood.The mNGS analysis of BALF showed that the detection depth of 5 loci and 3 loci in Streptococcus mitis genome was more than 100 and more than 200,and the detection depth of 4 loci in Streptococcus pneumoniae was more than 100,but none of them exceeded 200.After applying antibiotics according to the mNGS results,all patients'symptoms disappeared.The BALF was also identified as Streptococcus mitis.Conclusion The pathogen of this unexplained cluster fever event is Streptococcus mitis.The mNGS analysis has a good guiding role in the positive coping of unexplained cluster fever events.

关 键 词：聚集性发热事件 宏基因组二代测序 病原体 缓症链球菌 

分 类 号：R446[医药卫生—诊断学]