PDF(Pubmed)
Abstract：
Legionella pneumonia, rhabdomyolysis, and acute kidney injury are called the Legionella triad, which is rare and associated with a poor outcome and even death. Early diagnosis and timely treatment are essential for these patients.
A 63-year-old man with cough, fever, and fatigue was initially misdiagnosed with common bacterial infection and given beta-lactam monotherapy but failed to respond to it. Conventional methods, including the first Legionella antibody test, sputum smear, and culture of sputum, blood, and bronchoalveolar lavage fluid (BALF) were negative. He was ultimately diagnosed with a severe infection of Legionella pneumophila by metagenomics next-generation sequencing (mNGS). This patient, who had multisystem involvement and manifested with the rare triad of Legionella pneumonia, rhabdomyolysis, and acute kidney injury, finally improved after combined treatment with moxifloxacin, continuous renal replacement therapy, and liver protection therapy.
Our results showed the necessity of early diagnosis of pathogens in severe patients, especially in Legionnaires\' disease, who manifested with the triad of Legionella pneumonia, rhabdomyolysis, and acute kidney injury. mNGS may be a useful tool for Legionnaires\' disease in limited resource areas where urine antigen tests are not available.
A 63-year-old man with cough, fever, and fatigue was initially misdiagnosed with common bacterial infection and given beta-lactam monotherapy but failed to respond to it. Conventional methods, including the first Legionella antibody test, sputum smear, and culture of sputum, blood, and bronchoalveolar lavage fluid (BALF) were negative. He was ultimately diagnosed with a severe infection of Legionella pneumophila by metagenomics next-generation sequencing (mNGS). This patient, who had multisystem involvement and manifested with the rare triad of Legionella pneumonia, rhabdomyolysis, and acute kidney injury, finally improved after combined treatment with moxifloxacin, continuous renal replacement therapy, and liver protection therapy.
Our results showed the necessity of early diagnosis of pathogens in severe patients, especially in Legionnaires\' disease, who manifested with the triad of Legionella pneumonia, rhabdomyolysis, and acute kidney injury. mNGS may be a useful tool for Legionnaires\' disease in limited resource areas where urine antigen tests are not available.
摘要：
■军团菌肺炎，横纹肌溶解症,急性肾损伤被称为军团菌三联症，这是罕见的，与不良结果甚至死亡有关。早期诊断和及时治疗对这些患者至关重要。
■一名63岁的男子咳嗽,发烧,疲劳最初被误诊为常见的细菌感染，并给予β-内酰胺单药治疗，但未能对其产生反应。常规方法,包括第一次军团菌抗体测试,痰涂片,和痰培养，血,支气管肺泡灌洗液（BALF）阴性。通过宏基因组学下一代测序（mNGS），他最终被诊断出患有严重的嗜肺军团菌感染。这个病人,多系统受累，表现为罕见的军团菌肺炎三联征，横纹肌溶解症,和急性肾损伤，莫西沙星联合治疗后最终好转，连续性肾脏替代疗法,和肝脏保护治疗。
■我们的结果表明，重症患者需要早期诊断病原体，尤其是军团病,表现为军团菌肺炎三联征，横纹肌溶解症,和急性肾损伤。在无法进行尿抗原检测的资源有限地区，mNGS可能是治疗军团病的有用工具。
■一名63岁的男子咳嗽,发烧,疲劳最初被误诊为常见的细菌感染，并给予β-内酰胺单药治疗，但未能对其产生反应。常规方法,包括第一次军团菌抗体测试,痰涂片,和痰培养，血,支气管肺泡灌洗液（BALF）阴性。通过宏基因组学下一代测序（mNGS），他最终被诊断出患有严重的嗜肺军团菌感染。这个病人,多系统受累，表现为罕见的军团菌肺炎三联征，横纹肌溶解症,和急性肾损伤，莫西沙星联合治疗后最终好转，连续性肾脏替代疗法,和肝脏保护治疗。
■我们的结果表明，重症患者需要早期诊断病原体，尤其是军团病,表现为军团菌肺炎三联征，横纹肌溶解症,和急性肾损伤。在无法进行尿抗原检测的资源有限地区，mNGS可能是治疗军团病的有用工具。
