PDF(Pubmed)
Abstract：
Legionella is an aerobic, gram-negative, intracellular pathogen and is an important cause of community-acquired pneumonia. Legionella pneumophila is the most common causative agent of Legionella pneumonia. Clinical diagnosis of Legionella pneumonia is challenging due to the lack of specific clinical manifestations and the low positive rates of conventional pathogen detection methods. In this study, we report a case of a patient with chronic myeloid leukemia who developed rigors and high fever after chemotherapy and immunotherapy. Chest computed tomography revealed consolidation in the left lower lobe of the lung and ground-glass opacities in both lower lobes. Multiple blood cultures showed Escherichia coli, Staphylococcus aureus, Bacillus licheniformis, and positive results in the β-D-glucan test (G test). The patient was treated with various sensitive antimicrobial agents, including meropenem plus fluconazole, meropenem plus carpofungin, and vancomycin. Unfortunately, the patient\'s condition gradually worsened and eventually resulted in death. On the following day of death, metagenomic next-generation sequencing (mNGS) of 1whole blood revealed L. pneumophila pneumonia with concurrent bloodstream infection (blood mNGS reads 114,302). These findings suggest that when conventional empirical antimicrobial therapy proves ineffective for critically ill patients with pneumonia, the possibility of combined Legionella infection must be considered, and mNGS can provide a diagnostic tool in such cases.
摘要：
军团菌是有氧的,革兰氏阴性,胞内病原体是社区获得性肺炎的重要病因。嗜肺军团菌是军团菌肺炎的最常见病原体。由于缺乏特异性临床表现和常规病原体检测方法的阳性率低，军团菌肺炎的临床诊断具有挑战性。在这项研究中,我们报道了一例慢性髓细胞性白血病患者,该患者在化疗和免疫治疗后出现寒战和高烧.胸部计算机断层扫描显示左肺下叶实变，两个下叶均有毛玻璃混浊。多次血培养显示大肠杆菌，金黄色葡萄球菌,地衣芽孢杆菌,以及β-D-葡聚糖试验(G试验)的阳性结果。病人接受各种敏感的抗菌药物治疗,包括美罗培南加氟康唑,美罗培南加上卡波芬金,和万古霉素.不幸的是,患者病情逐渐恶化，最终导致死亡。在死亡的第二天，1全血的宏基因组下一代测序（mNGS）显示肺炎支原体肺炎并发血流感染（血液mNGS读数为114,302）。这些发现表明，当常规经验性抗菌治疗对重症肺炎患者无效时，必须考虑军团菌联合感染的可能性，和mNGS可以在这种情况下提供诊断工具。
