脓胸是肺癌肺部手术的并发症之一,发病率不是很高,但是在严重的情况下,甚至会导致死亡,用常规方法诊断病因总是很困难的。
在这项研究中,我们报道了一例55岁男性患者肺部手术后由卤菌引起的脓胸的临床病例.他发烧了,咳嗽,并排痰3天,诊断为右侧液气胸和脓胸,肺炎,术后右下叶恶性肿瘤(腺癌),和高血压。微生物学实验室报告胸腔积液中有革兰氏阴性菌,根据培养和16SrRNA测序初步认为是埃肯纳氏菌。此外,对痰样本进行了两次宏基因组下一代测序(mNGS),报告结果为阴性,并且存在大肠杆菌,分别。通过全基因组测序,最终确定病原体为卤虫,提示mNGS在该病例的临床诊断中的高分辨率能力。
据我们所知,这是中国首例Halliae感染病例报告,表明埃肯纳氏菌的致病性增加。在免疫功能低下的患者中,尤其是在侵入性手术之后。我们的发现强调mNGS允许脓胸的细菌诊断,并且可以显着提高诊断的准确性。
Empyema is one of the complications of pulmonary surgery for lung cancer, the incidence of which is not very high, but in severe cases, it can even lead to death, and it is always difficult to diagnose the cause by conventional methods.
In this study, we report a clinical
case of empyema caused by Eikenella halliae after pulmonary surgery in a 55-year-old man. He had a fever, cough, and expectoration for 3 days and was diagnosed with right hydropneumothorax and empyema, pneumonia, postoperative malignant tumor of the right lower lobe (adenocarcinoma), and hypertension. The microbiology laboratory reported Gram-negative bacteria in pleural effusion, which was preliminarily considered as Eikenella based on culture and 16S rRNA sequencing. Furthermore, metagenomic next-generation sequencing (mNGS) of sputum samples was performed two times and reported negative results and the presence of E. halliae, respectively. The pathogen was finally confirmed as E. halliae by whole genome sequencing, suggesting the high-resolution ability of mNGS in the clinical diagnosis of this
case.
To our knowledge, this is the first
case report of E. halliae infection in China, indicating increased pathogenicity of Eikenella sp. in immunocompromised patients, especially after invasive operations. Our findings emphasize that mNGS allows bacterial diagnosis of empyema and can significantly improve the accuracy of the diagnosis.