肺泡灌洗液mNGS诊断鹦鹉热衣原体肺炎病例特点分析  

Characteristics analysis of Chlamydia psittaci pneumonia diagnosed through bronchoalveolar lavage fluid metagenomic next-generation sequencing

作　　者：封萌 李斌[1] 金浩 王韵 彭景翠 池亚茜 胡文霞[1] 丁翠敏[1] Feng Meng;Li Bin;Jin Hao;Wang Yun;Peng Jingcui;Chi Yaqian;Hu Wenxia;Ding Cuimin(Department of Respiratory Medicine,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050012,China)

机构地区：[1]河北医科大学第四医院呼吸内科,石家庄050012

出　　处：《国际呼吸杂志》2022年第14期1069-1073,共5页International Journal of Respiration

摘　　要：目的探讨鹦鹉热衣原体肺炎临床特点、诊断、治疗。方法分析2019年12月至2021年2月河北医科大学第四医院呼吸内科收治的3例鹦鹉热衣原体肺炎患者的病例特点、诊疗过程,总结其临床特点、诊断、治疗。结果3例患者均急性起病,主要表现为发热、咳嗽,均有鸟类、家禽接触史。部分患者白细胞、降钙素原增高,3例患者C反应蛋白均增高,部分患者合并Ⅰ型呼吸衰竭,3例患者胸部影像学均表现为片状模糊渗出影,部分边缘不清,内可见支气管充气征。3例患者均通过肺泡灌洗液宏基因组二代测序(mNGS)诊断,检出鹦鹉热衣原体,予以针对性治疗,抗感染治疗后病情好转。结论mNGS诊断鹦鹉热衣原体感染是可行的;经支气管镜行肺泡灌洗液检测病原微生物的方法,因其没有口腔定植菌污染,取得下呼吸道标本可信度较高,针对经验性抗感染治疗效果不佳或非典型病原体感染患者可通过肺泡灌洗液mNGS明确感染源,指导后续治疗,今后在临床工作中的应用也会越来越广泛。Objective To investigate the clinical features,diagnosis,and treatment of Chlamydia psittaci pneumonia.Methods The characteristics,diagnosis,and treatment of three patients with chlamydia psittaci pneumonia admitted to the Department of Respiratory Medicine,the Fourth Hospital of Hebei Medical University from December 2019 to February 2021 were summarized.Results All the three patients had acute onset,mainly fever and cough,and had contact history with birds and poultry.The levels of leucocyte and procalcitonin were significantly increased in some patients,C-reactive protein was significantly increased in all three patients,type I respiratory failure was found in some patients,and all three cases showed patchy fuzzy exudation,partly indistinct edge,and air bronchogram under imaging examination.All patients were diagnosed by bronchoalveolar lavage fluid metagenomic next-generation sequencing(mNGS)and Chlamydophila psittaci were detected.Conclusions It is feasible to diagnose Chlamydophila psittaci infection with mNGS.Due to the absence of oral colonization,the lower respiratory tract specimen shows high reliability through bronchoalveolar lavage fluid pathogenic microorganisms detection.mNGS can be used to identify the source of infection and guide the follow-up treatment of the patients with poor empiric anti-infection treatment or with atypical pathogen infection.We hope it will be widely used in the future clinical work.

关 键 词：肺炎 鹦鹉衣原体 支气管肺泡灌洗液 宏基因组二代测序 

分 类 号：R563.1[医药卫生—呼吸系统]