UNASSIGNED: A 26-year-old man became ill suddenly with pneumonia after swimming in a river. Despite intensive support measures in the intensive care unit, he died 13 hours after admission and 4 days after his first symptoms. Autopsy showed abundant Gram-negative bacteria, massive inflammatory cell infiltration, edema, necrosis and hemorrhage in lung tissue. A. dhakensis was isolated from blood culture taken at admission and bronchoalveolar lavage fluid (BALF) after intubation. Moreover, A. dhakensis was also detected in lung tissue by metagenomic next-generation sequencing (mNGS) assay. The infection may have come from river water.
UNASSIGNED: In patients who develop a fulminant pneumonia after contacting an aquatic environment, A. dhakensis should be alerted and mNGS may aid in the detection of aquatic pathogens by being more sensitive and specific versus traditional bacterial culture.
■一名26岁的男子在河里游泳后突然患上肺炎。尽管重症监护室采取了密集的支持措施,他在入院后13小时和首次出现症状后4天死亡。尸检显示革兰氏阴性菌丰富,大量炎症细胞浸润,水肿,肺组织坏死和出血。从入院时的血培养物和插管后的支气管肺泡灌洗液(BALF)中分离出达克氏A。此外,还通过宏基因组下一代测序(mNGS)测定在肺组织中检测到达克酵母。感染可能来自河水。
■接触水生环境后出现暴发性肺炎的患者,应提醒dhakensis,mNGS可以通过比传统细菌培养更敏感和特异性来帮助检测水生病原体。