PDF(Pubmed)
Abstract：
Fusarium solani, as an opportunistic pathogen, can infect individuals with immunosuppression, neutropenia, hematopoietic stem cell transplantation (HSCT), or other high-risk factors, leading to invasive or localized infections. Particularly in patients following allogeneic HSCT, Fusarium solani is more likely to cause invasive or disseminated infections. This study focuses on a pediatric patient who underwent HSCT for severe aplastic anemia. Although initial blood cultures were negative, an abnormality was detected in the 1,3-β-D-glucan test (G test) post-transplantation. To determine the causative agent, blood samples were subjected to metagenomic next-generation sequencing (mNGS) and blood cultures simultaneously. Surprisingly, the results of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and mNGS differed slightly, with mNGS identifying Nectria haematonectria, while MALDI-TOF MS based on culture showed Fusarium solani. To clarify the results, Sanger sequencing was performed for further detection, and the results were consistent with those of MALDI-TOF MS. Since the accuracy of Sanger sequencing is higher than that of mNGS, the diagnosis was revised to invasive Fusarium solani infection. With advancements in technology, various detection methods for invasive fungi have been developed in recent years, such as mNGS, which has high sensitivity. While traditional methods may be time-consuming, they are important due to their high specificity. Therefore, in clinical practice, it is essential to utilize both traditional and novel detection methods in a complementary manner to enhance the diagnosis of invasive fungal infections.
摘要：
镰刀菌,作为一种机会病原体，可以感染免疫抑制的个体，中性粒细胞减少症,造血干细胞移植（HSCT），或其他高风险因素，导致侵入性或局部感染。特别是在同种异体HSCT后的患者中，镰刀菌更容易引起侵袭性或播散性感染。这项研究的重点是接受HSCT治疗严重再生障碍性贫血的儿科患者。虽然最初的血培养是阴性的，移植后1,3-β-D-葡聚糖试验(G试验)检测到异常.为了确定病原体，同时对血液样本进行宏基因组下一代测序(mNGS)和血液培养.令人惊讶的是,基质辅助激光解吸/电离飞行时间质谱（MALDI-TOFMS）和mNGS的结果略有不同，通过mNGS识别出坏死性血细胞坏死性，而基于培养的MALDI-TOFMS显示镰刀菌。为了澄清结果，进行Sanger测序以进一步检测，结果与MALDI-TOFMS的结果一致。由于Sanger测序的准确性高于mNGS，诊断改为侵袭性镰刀菌感染.随着技术的进步，近年来开发了各种入侵真菌的检测方法，比如MNGS，具有高灵敏度。虽然传统方法可能很耗时，由于它们的高特异性，它们是重要的。因此,在临床实践中，必须以互补的方式利用传统和新的检测方法来增强侵袭性真菌感染的诊断。
