宏基因组下一代测序技术对粪类圆线虫病合并其他病原体感染的诊断价值  

Diagnostic value of metagenomic next-generation sequencing for Strongyloides stercoralis coinfected with other pathogens

作　　者：谭妮 廖荣煌 汪单兰 苏梦婷 欧阳能太 TAN Ni;LIAO Ronghuang;WANG Danlan;SU Mengting;OUYANG Nengtai(Department of Cellular&Molecular Diagnostics Center,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou,Guangdong 510000,China)

机构地区：[1]中山大学孙逸仙纪念医院细胞分子诊断中心,广东广州510000

出　　处：《中国热带医学》2023年第12期1346-1352,共7页China Tropical Medicine

摘　　要：目的探讨宏基因组下一代测序技术(metagenomic next-generation sequencing,mNGS)对于粪类圆线虫病(strongyloidiasis)合并其他病原体感染的诊断价值和优势。方法根据纳入和排除标准,回顾性收集2020年11月至2022年10月就诊于中山大学孙逸仙纪念医院并诊断为粪类圆线虫病的5例患者临床资料。分析患者临床特征,比较5例患者共6份样本通过使用mNGS、液基细胞学镜检方法对粪类圆线虫(Strongyloides stercoralis)的检出率,并与采用粪便直接涂片法对5例患者的粪便查找粪类圆线虫虫卵的检出率进行比较。分析比较6份样本的mNGS与细菌和真菌培养结果的一致性。结果5例患者中有3例为农民。5例患者均存在基础疾病,主要临床表现为发热、咳嗽,影像特征多为玻璃影、密度影。5例患者血常规检查结果中有4例提示中性粒细胞百分比升高,5例患者嗜酸性粒细胞均未见升高。5例患者的降钙素原均升高。5例患者6份样本中,mNGS对粪类圆线虫的检出率为100%,液基细胞学镜检的检出率为50%。5例患者采用粪便直接涂片法查找粪类圆线虫虫卵的检出率为20%。6份样本中,mNGS均检测到人类疱疹病毒5型,有3份样本检测到耶氏肺孢子菌,3份样本检测到烟曲霉菌,2份样本检测到铜绿假单胞菌。除去mNGS检测到的粪类圆线虫和病毒,将培养结果与mNGS检出的细菌和真菌结果进行比较,有1例样本完全一致,2例样本不一致,3例样本部分一致。结论mNGS对于粪类圆线虫的检出率可能高于粪便直接涂片法和液基细胞学镜检法。相对于常规细菌和真菌培养,mNGS检测范围广,可能更适合用于粪类圆线虫病合并其他病原体感染的检测,对于混合感染具有明显的诊断优势,可能可以作为粪类圆线虫病的早期诊断方法。Objective To explore the diagnostic value and advantage of metagenomic next-generation sequencing(mNGS)in the diagnosis of Strongyloidiasis co-infected with other pathogens.Methods According to the inclusion and exclusion criteria,the clinical data of 5 patients diagnosed with Strongyloides stercoralis in Sun Yat-sen Memorial Hospital,Sun Yat-sen University from November 2020 to October 2022 were retrospectively collected.The clinical characteristics of the patients were analyzed,and the positive rates of Strongyloides stercoralis in 6 samples from 5 patients were compared by using mNGS and liquid-based cytology microscopy,and the detection rates of Strongyloides stercoralis eggs in the feces of 5 patients were compared by using the fecal direct smear method.The consistency between mNGS and bacterial and fungal culture results of the 6 samples was analyzed and compared.Results Three of the 5 patients were farmers.All 5 patients had underlying diseases,with fever and cough as the main clinical manifestations,and the imaging features were mostly glass shadow and density shadow.Blood routine examination showed an increase in the percentage of neutrophils in 4 of the 5 patients,and none of the 5 patients had an increase in eosinophils.Procalcitonin levels were elevated in all five patients.Among the 6 samples from the 5 patients,the detection rate of Strongyloides stercoralis detection by mNGS was 100%,and the detection rate of liquid-based cytology was 50%.The detection rate of Strongyloides stercoralis eggs using the direct fecal smear method was 20%in 5 patients.Among the 6 samples,Human betaherpesvirus 5 was detected by mNGS,and Pneumocystis jirovecii was detected in 3 samples,Aspergillus fumigates was detected in 3 samples,and Pseudomonas aeruginosa was detected in 2 samples.Except for Strongyloides stercoralis and viruses detected by mNGS,the results of routine culture were completely consistent with those of bacteria and fungi detected by mNGS in 1 sample,inconsistent in 2 samples,and partially consistent in 3

关 键 词：基因组下一代测序技术 粪类圆线虫 混合感染 

分 类 号：R446.5[医药卫生—诊断学]