非结核性分枝杆菌肺病(NTM-LD)的发病率在全球范围内不断增加,其表现与结核病(TB)的相似,对NTM-LD的诊断和治疗提出了巨大的挑战。通常被误诊为结核病。早期正确的诊断和治疗可以极大地改善患者的预后。
通过病例1的肺组织和病例2的细支气管肺泡液中的mNGS鉴定了分枝杆菌,但使用常规微生物学方法未鉴定。在已经传播NTM感染的病例3的血液mNGS样品中检测到多种NTM物种。虽然NTM是从血培养物中分离出来的,传统的方法无法识别生物的物种水平。所有三名患者都患有骨髓增生异常综合征并正在接受治疗,类风湿性关节炎,系统性红斑狼疮,或者急性淋巴细胞白血病,使它们受到免疫抑制和NTM感染。病例1和病例2在抗NTM治疗后显着改善,但病例3尽管积极治疗,但由于潜在的医学疾病而死于感染。
本研究中的病例证明了mNGS在促进和改善NTM感染的临床诊断方面的有效性。我们建议将mNGS与传统诊断方法相结合,以在疾病的早期阶段识别病原体,从而可以实施针对性治疗。
The increasing worldwide incidence of nontuberculous mycobacterial lung disease (NTM-LD) and the similarity of its manifestations to those of tuberculosis (TB) pose huge challenges in the diagnosis and treatment of NTM-LD, which is commonly misdiagnosed and mistreated as TB. Proper diagnosis and treatment at an early stage can greatly improve patient outcomes.
Mycobacterium avium was identified by mNGS in lung tissue of
case 1 and bronchioalveolar fluid from
case 2 that was not identified using conventional microbiological methods. Multiple NTM species were detected in the blood mNGS samples from
case 3 who had disseminated NTM infection. Although NTM was isolated from blood culture, conventional methods failed to identify the organisms to the level of species. All three patients were suffering from and being treated for myelodysplastic syndrome, rheumatoid arthritis, systemic lupus erythematosus, or acute lymphoblastic leukemia, making them immunosuppressed and susceptible to NTM infections.
Case 1 and
Case 2 significantly improved after anti-NTM treatment, but
case 3 succumbed to the infection due to her underlying medical illness despite aggressive treatment.
The cases in this study demonstrate the effectiveness of mNGS in facilitating and improving the clinical diagnosis of NTM infections. We propose combining mNGS with traditional diagnostic methods to identify pathogens at the early stages of the disease so that targeted treatment can be implemented.