基于mNGS诊断的3例鹦鹉热衣原体肺炎报道并文献复习  

Case report of three Chlamydia psittaci pneumonia diagnosed with metagenome next-generation sequencing and literature review

作　　者：张伟[1] 和平[1] 石婕[1] 赵凯凯 冯雁京 王煜[1] 孙秀珍[1] Zhang Wei;He Ping;Shi Jie;Zhao Kaikai;Feng Yanjing;Wang Yu;Sun Xiuzhen(Department of Respiratory and Critical Care Medicine,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi/an 710000,China;Department of Cardiologyt the Second Affiliated Hospital of Xian J iaotong University,Xi/an 710000,China)

机构地区：[1]西安交通大学第二附属医院呼吸与危重症医学科,西安710000 [2]西安交通大学第二附属医院心内科,西安710000

出　　处：《国际呼吸杂志》2022年第14期1080-1084,共5页International Journal of Respiration

摘　　要：目的探讨鹦鹉热衣原体感染临床特征、诊断及治疗方案。方法收集3例鹦鹉热衣原体肺炎患者的临床资料和鹦鹉热衣原体基因序列,回顾其诊疗经过及预后,结合国内外相关文献,对该病例的临床表现、影像学特征、实验室检查、诊治经过及预后情况进行分析,同时利用耐药数据库进行耐药基因识别。结果本研究通过肺泡灌洗液的宏基因组二代测序(mNGS)检查快速准确地诊断了鹦鹉热衣原体肺炎,在多西环素、莫西沙星的治疗下患者症状缓解明显,3例样本中均未找到耐药基因。结论鹦鹉热衣原体肺炎主要表现为发热、气促,病情进展较快,但临床症状和常规实验室检查均缺乏特异性,禽类、哺乳动物接触史对诊断有重要价值。肺泡灌洗液mNGS能帮助临床快速明确诊断,早期使用多西环素、喹诺酮类药物治疗效果显著。Objective To investigate the clinical characteristics,diagnosis,and treatment of Chlamydia psittaci infection.Methods The clinical data and the sequence of Chlamydia psittaci pneumonia DNA were collected from three cases of Chlamydia psittacosis,and their diagnosis,treatment,and prognosis were reviewed.Combined with relevant domestic and foreign literatures,the clinical characteristics,diagnosis,treatment,and prognosis of the disease were summarized.The antimicrobial resistance gene database was used to screen resistance genes.Results In this study,we accurately diagnosed Chlamydia psittaci infection through examination of alveolar lavage fluid by metagenomics next-generation sequencing(mNGS).The symptoms of patients were significantly relieved under the treatment of moxifloxacin and doxycycline.No antimicrobial resistance gene was discovered in three cases.Conclusions The main manifestations of Chlamydia psittaci pneumonia are fever and shortness of breath.The disease progresses rapidly,but the clinical symptoms and results of routine laboratory examination are lack of specificity.The contact history of birds and mammals plays an important role in diagnosis.Test of alveolar lavage fluid via mNGS can help clinical diagnosis,and early treatment with doxycycline and Quinolone antimicrobial agents produces a significant effect.

关 键 词：肺炎 鹦鹉衣原体 宏基因组二代测序 多西环素 喹诺酮类 

分 类 号：R563.1[医药卫生—呼吸系统]