Successful treatment of disseminated nocardiosis diagnosed by metagenomic next-generation sequencing:A case report and review of literature  

作　　者：Ting Li Yi-Xin Chen Jia-Jia Lin Wei-Xian Lin Wei-Zhen Zhang Hang-Ming Dong Shao-Xi Cai Ying Meng 

机构地区：[1]Department of Respiratory and Critical Care Medicine,Nanfang Hospital,Southern Medical University,Guangzhou 510515,Guangdong Province,China

出　　处：《World Journal of Clinical Cases》2022年第28期10120-10129,共10页世界临床病例杂志

基　　金：Supported by the Project of Nanfang Hospital President Foundation of Southern Medical University,No.2019C006。

摘　　要：BACKGROUND Nocardia paucivorans is an infrequently found bacterium with the potential to cause severe infection,with a predilection for the central nervous system,both in immunocompromised and immunocompetent individuals.Rapid etiological diagnosis of nocardiosis can facilitate timely and rational antimicrobial treatment.Metagenomic next-generation sequencing(m NGS)can improve the rate and reduce the turnaround time for the detection of Nocardia.CASE SUMMARY A 49-year-old man was admitted to hospital with cough and hemoptysis.Imaging revealed pulmonary consolidation as well as multiple brain lesions.Nocardia asiatica and Nocardia beijingensis were rapidly detected by m NGS of bronchoalveolar lavage fluid(BALF)while bacterial culture of BALF and pathological biopsy of lung tissue were negative.In early stages,he was treated with trimethoprim-sulfamethoxazole(TMP-SMZ)and linezolid by individual dose adjustment based on serum concentrations and the adverse effects of thrombocytopenia and leukopenia.The treatment was then replaced by TMP-SMZ and ceftriaxone or minocycline.He was treated with 8 mo of parenteral and/or oral antibiotics,and obvious clinical improvement was achieved with resolution of pulmonary and brain lesions on repeat imaging.CONCLUSION m NGS provided fast and precise pathogen detection of Nocardia.In disseminated nocardiosis,linezolid is an important alternative that can give a better outcome with the monitoring of linezolid serum concentrations and platelet count.

关 键 词：Disseminated nocardiosis Metagenomic next-generation sequencing LINEZOLID THROMBOCYTOPENIA Case report 

分 类 号：R519.1[医药卫生—内科学]