背景:解肝素普氏菌是一种革兰氏阴性细菌,常见于口服,肠,和尿道。它已经在马下呼吸道感染中得到了广泛的研究,具有肝素分解活性,能分泌肝素酶,进一步诱导细胞内的毒力因子,引起疾病。然而,在人类中没有此类病例的报道。
方法:一名来自中国的58岁男性患者出现在苏州的呼吸诊所,咳嗽产生白色痰20天,发烧3天。在这次访问之前,进行了胸部计算机断层扫描,显示两肺有多个斑片状结节混浊。一入场,患者的体温为38.1°C,脉搏率为110次/分钟。尽管使用莫西沙星进行常规抗感染治疗,他的体温波动,治疗无效。通过宏基因组下一代测序,该患者被诊断为解肝素普氏菌感染。因此,抗生素改用哌拉西林-他唑巴坦联合奥硝唑,缓解了他的症状;出院后一周,患者返回诊所进行胸部计算机断层扫描随访,肺部的混浊继续被吸收。
结论:解肝素普氏菌是一种机会致病菌。然而,在人类肺炎中没有报道。在难治性肺炎中,宏基因组下一代测序等措施可用于识别病原体,并帮助指导抗生素选择和早期支持。
BACKGROUND: Prevotella heparinolytica is a Gram-negative bacterium that is commonly found in the oral, intestinal, and urinary tracts. It has been extensively studied in lower respiratory tract infections in horses, which has heparinolytic activity and can secrete heparinase and further induces virulence factors in cells and causes disease. However, no such cases have been reported in humans.
METHODS: A 58-year-old male patient from China presented to the respiratory clinic in Suzhou with a productive cough producing white sputum for 20 days and fever for 3 days. Prior to this visit, a chest computed tomography scan was conducted, which revealed multiple patchy nodular opacities in both lungs. On admission, the patient presented with a temperature of 38.1 °C and a pulse rate of 110 beats per minute. Despite routine anti-infective treatment with moxifloxacin, his temperature fluctuated and the treatment was ineffective. The patient was diagnosed with
Prevotella heparinolytica infection through metagenomic next-generation sequencing. Therefore, the antibiotics were switched to piperacillin-tazobactam in combination with ornidazole, which alleviated his symptoms; 1 week after discharge, the patient returned to the clinic for a follow-up chest computed tomography, and the opacities on the lungs continued to be absorbed.
CONCLUSIONS: Prevotella heparinolytica is an opportunistic pathogen. However, it has not been reported in human pneumonia. In refractory pneumonia, measures such as metagenomic next-generation sequencing can be used to identify pathogens and help guide antibiotic selection and early support.