Next-generation sequencing (NGS)

下一代测序 ( NGS )
  • 文章类型: Journal Article
    背景尽管慢性粒细胞白血病(CML)遗传学有进展,一氧化氮(NO)和硫化氢(H2S)基因突变的作用及其与凋亡基因的关系尚不清楚。因此,这项研究使用Sanger测序和下一代测序(NGS)调查了NO和H2S产生基因突变及其与凋亡基因的相互作用。方法进行全血细胞计数(CBC)以测量白细胞的总数,而IL-6水平在对照和CML患者中使用ELISA技术进行评估。Sanger测序用于分析CTH和NOS3基因的突变,而NGS用于检查所有染色体上的突变。结果CML患者的白细胞(WBC)和粒细胞计数明显高于对照组(p<0.0001),和单核细胞计数类似地更高(p<0.05)。白细胞介素-6(IL-6)水平在CML患者中显著高于对照组(p<0.0001),表明可能与CML病因或进展有关。已经在这两个基因中发现了多个突变,特别是在CTH外显子12和NOS3基因VNTR中,T786C,和G894T。本研究还使用IL-6测定法测量IL-6浓度,确定其作为CML预后诊断的潜力。白细胞计数,粒细胞计数,和中档绝对计数,或MID计数,CML患者明显高于正常对照组。NGS在CML患者中鉴定出1643个体细胞和性染色体异常和439个活跃表达的基因。与其他数据库相比,该发现暗示了CML发展中BCR-ABL1突变之外的基因组景观。结论总之,本研究通过鉴定NO-和H2S产生基因的突变及其与凋亡相关基因的复杂联系,促进了对CML遗传特征的理解.通过Sanger测序和NGS获得的全面遗传图谱为确定CML的治疗和个性化治疗的新目标提供了可能性。因此有助于血液病的发展。
    Background Despite advances in chronic myeloid leukemia (CML) genetics, the role of nitric oxide (NO) and hydrogen sulfide (H2S) gene mutations and their relationship to apoptotic genes is unclear. Therefore, this study investigated NO- and H2S-producing genes\' mutations and their interactions with apoptotic genes using Sanger sequencing and next-generation sequencing (NGS). Methodology A complete blood count (CBC) was carried out to measure the total number of white blood cells, while IL-6 levels were assessed in both control and CML patients using an ELISA technique. Sanger sequencing was used to analyze mutations in the CTH and NOS3 genes, whereas NGS was applied to examine mutations on all chromosomes. Results White blood cell (WBC) and granulocyte counts were significantly higher in CML patients compared to controls (p<0.0001), and monocyte counts were similarly higher (p<0.05). Interleukin-6 (IL-6) levels were significantly elevated in CML patients than controls (p<0.0001), indicating a possible link to CML etiology or progression. Multiple mutations have been identified in both genes, notably in CTH exon 12 and the NOS3 genes VNTR, T786C, and G894T. This study also measured IL-6 concentrations using IL-6 assays, identifying its potential as a CML prognostic diagnostic. WBC counts, granulocyte counts, and mid-range absolute counts, or MID counts, were significantly higher in CML patients than in normal control individuals. NGS identified 1643 somatic and sex chromosomal abnormalities and 439 actively expressed genes in CML patients. The findings imply a genomic landscape beyond the BCR-ABL1 mutation in CML development compared to other databases. Conclusion In conclusion, this study advances the understanding of the genetic characteristics of CML by identifying mutations in the NO- and H2S-producing genes and their complex connections with genes involved in apoptosis. The comprehensive genetic profile obtained by Sanger sequencing and NGS provides possibilities for identifying novel targets for therapy and personalized treatments for CML, therefore contributing to developments in hematological diseases.
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  • 文章类型: Journal Article
    甲型肝炎病毒(HAV),肝病毒属(PicornaviridaeHepV)的成员,仍然是一种重要的病毒病原体,经常在全球范围内引起经肠传播的肝炎。在这项研究中,我们对云南省野生小型陆生哺乳动物携带的HepV进行了流行病学调查,中国。利用HepV特异性广谱RT-PCR,下一代测序(NGS),和QNome纳米孔测序(QNS)技术,我们鉴定并表征了两种暂时命名为EpMa-HAV和EpLe-HAV的新型HepV,发现于长尾山sh(Episoriculusmacrurus)和长尾棕齿sh(Episoriculusleucops)中,分别。我们对EpMa-HAV和EpLe-HAV的序列和系统发育分析表明它们属于I型肝病毒(HepV-I)进化枝II,也被称为中国泼妇HepV进化枝。值得注意的是,新型HepV的密码子使用偏倚模式与先前鉴定的中国HepV一致。此外,我们的结构分析表明,与其他哺乳动物HepVs的RNA二级结构不同,并且在关键蛋白位点表现出差异.总的来说,在the中发现了两个新的HepV,扩大了HepV的宿主范围,并强调了HepV属中人类HAV的遗传多样性动物同源物的存在。
    Hepatitis A virus (HAV), a member of the genus Hepatovirus (Picornaviridae HepV), remains a significant viral pathogen, frequently causing enterically transmitted hepatitis worldwide. In this study, we conducted an epidemiological survey of HepVs carried by small terrestrial mammals in the wild in Yunnan Province, China. Utilizing HepV-specific broad-spectrum RT-PCR, next-generation sequencing (NGS), and QNome nanopore sequencing (QNS) techniques, we identified and characterized two novel HepVs provisionally named EpMa-HAV and EpLe-HAV, discovered in the long-tailed mountain shrew (Episoriculus macrurus) and long-tailed brown-toothed shrew (Episoriculus leucops), respectively. Our sequence and phylogenetic analyses of EpMa-HAV and EpLe-HAV indicated that they belong to the species Hepatovirus I (HepV-I) clade II, also known as the Chinese shrew HepV clade. Notably, the codon usage bias pattern of novel shrew HepVs is consistent with that of previously identified Chinese shrew HepV. Furthermore, our structural analysis demonstrated that shrew HepVs differ from other mammalian HepVs in RNA secondary structure and exhibit variances in key protein sites. Overall, the discovery of two novel HepVs in shrews expands the host range of HepV and underscores the existence of genetically diverse animal homologs of human HAV within the genus HepV.
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  • 文章类型: Journal Article
    建立模块结合剂作为诊断检测剂代表了一次产生一个分子的常用结合剂的成本和时间有效的替代方案。与这些传统方法相比,模块化粘合剂可以从单个模块设计到,原则上,识别任何所需的线性表位,而无需经过选择和命中验证过程,给定一组预先存在的,氨基酸特异性模块。设计的Armadillo重复蛋白(dArmRP)已被开发为模块化粘合剂支架,我们在这里报告通过酵母表面显示选择生成高度特异性的dArmRP模块,在合理设计的dArmRP库上执行。开发了一种选择策略来区分由靶肽中的单个氨基酸突变产生的结合差异。在此引入的我们的反向竞争策略采用指定的靶标作为竞争物,以增加当从对靶标肽显示相似亲和力的交叉反应性结合物中分离特异性时的灵敏度。随着选择焦点从亲和力到特异性的转变,我们发现在这种特异性排序过程中的富集表明了所需的表型,无论粘合剂的丰度。因此,选择池的深度测序允许仅从下一代测序数据中检索选择性分选池中只有0.1%丰度的表型命中.在一项原理证明研究中,通过用新选择的模块替换所有相应的野生型模块来创建活页夹,产生对指定靶标具有非常高亲和力的结合剂,该结合剂已在蛋白质印迹分析中成功验证为检测剂。
    Establishing modular binders as diagnostic detection agents represents a cost- and time-efficient alternative to the commonly used binders that are generated one molecule at a time. In contrast to these conventional approaches, a modular binder can be designed in silico from individual modules to, in principle, recognize any desired linear epitope without going through a selection and hit-validation process, given a set of preexisting, amino acid-specific modules. Designed armadillo repeat proteins (dArmRP) have been developed as modular binder scaffolds, and we report here the generation of highly specific dArmRP modules by yeast surface display selection, performed on a rationally designed dArmRP library. A selection strategy was developed to distinguish the binding difference resulting from a single amino acid mutation in the target peptide. Our reverse-competitor strategy introduced here employs the designated target as a competitor to increase the sensitivity when separating specific from cross-reactive binders that show similar affinities for the target peptide. With this switch in selection focus from affinity to specificity, we found that the enrichment during this specificity sort is indicative of the desired phenotype, regardless of the binder abundance. Hence, deep sequencing of the selection pools allows retrieval of phenotypic hits with only 0.1% abundance in the selectivity sort pool from the next-generation sequencing data alone. In a proof-of-principle study, a binder was created by replacing all corresponding wild-type modules with a newly selected module, yielding a binder with very high affinity for the designated target that has been successfully validated as a detection agent in western blot analysis.
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  • 文章类型: Journal Article
    在算法之间进行选择以及评估算法的HLA分型预测时,了解HLA分型算法的预期准确性很重要。本章指导读者通过一个示例基准测试研究,该研究评估了四个基于NGS的HLA分型算法的性能以及需要考虑的概述因素,在设计和运行这样的基准研究时。可以在https://github.com/nikolasthuesen/springers-hla-benchmark/上找到与此基准测试工作流程相关的代码。
    Knowledge of the expected accuracy of HLA typing algorithms is important when choosing between algorithms and when evaluating the HLA typing predictions of an algorithm. This chapter guides the reader through an example benchmarking study that evaluates the performances of four NGS-based HLA typing algorithms as well as outlining factors to consider, when designing and running such a benchmarking study. The code related to this benchmarking workflow can be found at https://github.com/nikolasthuesen/springers-hla-benchmark/ .
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  • 文章类型: Journal Article
    皮肤鳞状细胞癌是一种常见的恶性肿瘤,发病率上升,突变负荷显著高。探索cSCC的遗传细微差别和研究分子方法是改善高危患者预后的潜在途径。这项回顾性病例对照研究涉及两个队列,14名患者中的一名(“发现队列”)和12名患者中的另一名(“验证队列”),cSCC位于头/颈部解剖区域,并在pT2阶段诊断。总的来说,病例出现早期局部复发,而对照组在整个随访期间从未复发。对组织学样品进行的下一代测序(NGS)方法显示,TP53和CDKN2A是我们系列中最常见的突变基因。没有特异性突变被鉴定为潜在的预后或治疗靶标。与病例相比,对照显示出更高的突变率趋势。突变数量的增加可能会促使cSCC暴露更多的抗原,变得更具免疫原性并促进免疫系统的识别。这可以增强和维持免疫反应,可能会阻止未来的复发。
    Cutaneous squamous cell carcinoma is a prevalent malignancy with a rising incidence and a notably high mutational load. Exploring the genetic nuances of cSCC and investigating molecular approaches stands as a potential avenue for improving outcomes in high-risk patients. This retrospective case-control study involved two cohorts, one of 14 patients (the \"discovery cohort\") and the other of 12 patients (the \"validation cohort\"), with cSCC located in the head/neck anatomical region and diagnosed at the pT2 stage. Overall, cases developed early local relapses of the disease, whereas controls never relapsed during the entire follow-up period. A next-generation sequencing (NGS) approach conducted on histological samples revealed that TP53 and CDKN2A were the most frequently mutated genes in our series. No specific mutations were identified as potential prognostic or therapeutic targets. Controls exhibited a tendency toward a higher mutational rate compared to cases. It is possible that an increased number of mutations could prompt the cSCC to expose more antigens, becoming more immunogenic and facilitating recognition by the immune system. This could enhance and sustain the immunological response, potentially preventing future recurrences.
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  • 文章类型: Journal Article
    “Pecorino”是一种典型的半硬奶酪,使用原料或热处理的羊奶,使用程序来提高原料的化学和微生物学特性。在本研究中,使用16SrRNA基因测序的高通量方法,我们使用来自Comisana和Lacaune绵羊品种的牛奶,在手工过程中评估了从牛奶到Pecorino样奶酪的微生物组组成的演变。对细菌群落组成的比较分析表明,在Comisana和Lacaune品种的牛奶微生物群中特定分类群的存在和丰度存在显着差异。下一代测序(NGS)分析还揭示了与奶牛养殖实践相关的凝乳微生物群的差异,对Pecorino奶酪微生物组的最终结构有相关影响。
    \"Pecorino\" is a typical semi-hard cheese obtained with raw or heat-treated sheep milk using procedures to valorize the raw material\'s chemical and microbiological properties. In the present study, using a high-throughput method of 16S rRNA gene sequencing, we assessed the evolution of the microbiome composition from milk to Pecorino-like cheese in artisanal processes using milk from Comisana and Lacaune sheep breeds. The comparative analysis of the bacterial community composition revealed significant differences in the presence and abundance of specific taxa in the milk microbiomes of the Comisana and Lacaune breeds. Next-Generation Sequencing (NGS) analysis also revealed differences in the curd microbiomes related to dairy farming practices, which have a relevant effect on the final structure of the Pecorino cheese microbiome.
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  • 文章类型: Journal Article
    在过去的十年中,肺腺癌(LUAD)的靶向治疗取得了重大进展。仅有少数靶向治疗剂被批准用于肺鳞状细胞癌(LUSC)的治疗。几种较高频率的基因改变被鉴定为在LUSC中潜在可行的。我们的工作旨在探索多种遗传改变和通路的复杂相互作用,有助于LUSC的发病机理。单驱动分子改变的频率非常低,以在未来开发更有效的治疗策略。
    我们回顾性分析了2019年1月至2023年3月在我们机构最初诊断为非小细胞肺癌(NSCLC)的335例患者的靶向下一代测序(NGS)数据(约600个基因),并探索了LUSC和LUAD之间的体细胞基因组改变差异。
    我们分析了功能丧失(LoF)突变的存在(无义,移码,组蛋白-赖氨酸N-甲基转移酶2D(KMT2D)中的剪接位点变体)在LUSC中(11/53,20.8%)比在LUAD中(6/282,2.1%)更为普遍。此外,我们的数据表明,在90.9%(10/11)的LUSC和33.3%(2/6)的LUAD中,TP53与KMT2DLoF共突变.值得注意的是,在共突变病例中,KMT2D的突变等位基因分数(MAF)与TP53非常相似。NSCLC驱动基因突变的基因组分析显示81.8%(9/11)的具有KMT2DLoF突变的LUSC患者具有PIK3CA扩增和/或FGFR1扩增。
    我们的结果提示KMT2D的体细胞LoF突变在LUSC中频繁发生,但在LUAD中频率较低,因此可能与LUSC的发病机制有关。同时TP53突变,FGFR1扩增,和PIK3CA扩增在具有KMT2DLoF突变的LUSC病例中非常常见。它需要对基因和通路的相互作用进行更深入的研究,并在未来使用更大的队列。
    UNASSIGNED: The significant progress has been made in targeted therapy for lung adenocarcinoma (LUAD) in the past decade. Only few targeted therapeutics have yet been approved for the treatment of lung squamous cell carcinoma (LUSC). Several higher frequency of gene alterations are identified as potentially actionable in LUSC. Our work aimed to explore the complex interplay of multiple genetic alterations and pathways contributing to the pathogenesis of LUSC, with a very low frequency of a single driver molecular alterations to develop more effective therapeutic strategies in the future.
    UNASSIGNED: We retrospectively analyzed the targeted next-generation sequencing (NGS) data (approximately 600 genes) of 335 patients initially diagnosed with non-small cell lung cancer (NSCLC) at our institution between January 2019 and March 2023 and explored the somatic genome alteration difference between LUSC and LUAD.
    UNASSIGNED: We analyzed that the presence of loss-of-function (LoF) mutations (nonsense, frameshift, and splice-site variants) in histone-lysine N-methyltransferase 2D (KMT2D) was much more prevalent in LUSC (11/53, 20.8%) than in LUAD (6/282, 2.1%). Moreover, our data indicated TP53 co-mutated with KMT2D LoF in 90.9% (10/11) LUSC and 33.3% (2/6) LUAD. Notably, the mutation allele fraction (MAF) of KMT2D was very similar to that of TP53 in the co-mutated cases. Genomic profiling of driver gene mutations of NSCLC showed that 81.8% (9/11) of the patients with LUSC with KMT2D LoF mutations had PIK3CA amplification and/or FGFR1 amplification.
    UNASSIGNED: Our results prompted that somatic LoF mutations of KMT2D occur frequently in LUSC, but are less frequent in LUAD and therefore may potentially contribute to the pathogenesis of LUSC. Concurrent TP53 mutations, FGFR1 amplification, and PIK3CA amplification are very common in LUSC cases with KMT2D LoF mutations. It needs more deeper investigation on the interplay of the genes and pathways and uses larger cohorts in the future.
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  • 文章类型: Journal Article
    在肺癌中,需要分子检测和下一代测序(NGS)来确定治疗靶标,并且越来越多地用于疾病的早期阶段.尽管它长期使用,目前尚不清楚经支气管针吸活检术(TBNA)对周围型肺病变是否像经支气管钳活检术(TBFBs)一样为基因检测提供了足够的材料.在这项研究中,我们的目标是使用中位活细胞面积(MVCA)作为分析样品质量的替代参数来分析TBNA.
    这项前瞻性单中心研究分析了接受支气管镜和经支气管活检的患者的活检标本或抽吸物。患者在周围性肺病变中接受了TBFB和TBNA的支气管镜检查,以怀疑肺癌。患者以1:1的比例随机接受TBFB或TBNA作为第一种活检技术,然后切换到另一种活检技术。例行检查后,样品载玻片进行了数字扫描,和MVCA由对所用活检技术不知情的病理学家计算。主要终点是TBNA与TBFB的MVCA。次要终点是并发症分类为出血,气胸,和其他。
    在2021年8月至2022年4月之间,15名患者被纳入符合方案分析。队列1中包括6名患者,队列2中包括9名患者。11/15(73.3%)例确诊为恶性诊断,其中9例是原发性肺部恶性肿瘤。总的来说,通过TBFB获得的样品中的MVCA明显大于TBNA样品{TBFB-MVCA9.80mm2[四分位间距(IQR),2.70-10.39mm2]vs.TBNA-MVCA2.70mm2(IQR,0.14-8.21mm2),P=0.008}。尽管有这种差异,分子测试在TBNA和TBFB样品中都是可行的。未观察到重大并发症。
    尽管TBNA提供了明显较小的MVCA,样品仍然被认为对NGS是可行的,这表明TBNA是在周围结节中获得足够肿瘤组织的替代方法,作为疑似肺癌诊断的一部分。
    UNASSIGNED: In lung cancer, molecular testing and next-generation sequencing (NGS) are needed to identify therapeutic targets and are increasingly being used in earlier stages of the disease. Despite its longstanding use, it remains unclear whether transbronchial needle aspiration (TBNA) of peripheral lung lesions provides as adequate material for genetic testing as transbronchial forceps biopsies (TBFBs). In this study, we aim to analyze the use of TBNA using median viable cell area (MVCA) as a surrogate parameter to analyze sample quality.
    UNASSIGNED: This prospective single-center study analyzed biopsy specimens or aspirates of patients who underwent bronchoscopy with transbronchial biopsy. Patients underwent bronchoscopy with TBFB and TBNA for suspected lung cancer in peripheral lung lesions. Patients were randomized 1:1 to receive either TBFB or TBNA as the first biopsy technique and then switched to the other. After routine workup, sample slides were digitally scanned, and MVCA was calculated by a pathologist blinded to the biopsy technique used. The primary endpoint was MVCA of TBNA versus TBFB. Secondary endpoints were complications categorized as bleeding, pneumothorax, and other.
    UNASSIGNED: Between August 2021 and April 2022, 15 patients were included in the per-protocol analysis. Six patients were included in cohort 1 and nine patients in cohort 2. A malignant diagnosis was confirmed in 11/15 (73.3%) cases, of which nine were primary lung malignancies. Overall, MVCA in samples obtained by TBFB was significantly larger than TBNA samples {TBFB-MVCA 9.80 mm2 [interquartile range (IQR), 2.70-10.39 mm2] vs. TBNA-MVCA 2.70 mm2 (IQR, 0.14-8.21 mm2), P=0.008}. Despite this difference, molecular testing was feasible in both TBNA and TBFB samples. No major complications were observed.
    UNASSIGNED: Despite a significantly smaller MVCA provided by TBNA, samples were still considered feasible for NGS, indicating that TBNA represents an alternative method to obtain sufficient tumor tissue in peripheral nodules as part of the diagnosis of suspected lung cancer.
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  • 文章类型: Journal Article
    背景:支气管内超声引导下经支气管针吸活检术(EBUS-TBNA)已用于肺癌的诊断和分期。Acquire™肺部和Expect™肺部专用EBUS-TBNA针头作为Franseen和Lancet针头引入,分别。尚不清楚Franseen或Lancet针头是否能产生更高质量的样本,尤其是专注于基于下一代测序的分子测试。
    方法:单中心,在千叶大学医院进行的前瞻性研究将患者随机分为两组:A组,其中第一和第二EBUS-TBNA使用柳叶刀和弗兰塞针进行,分别,B组,其中第一和第二EBUS-TBNA使用Franseen和Lancet针进行,分别。对各标本进行病理对比分析。主要结果是除了血凝块和每个样品的细胞数量之外的组织学组织面积。我们还检查了分子测试的成功率。
    结果:本研究纳入了2022年11月至2023年2月期间接受EBUS-TBNA的12例患者。通过Franseen和Lancet针获得的标本的组织面积分别为13.3±6.4mm2和10.6±6.3mm2(P=.355)。使用Franseen和Lancet针获得的标本中的肿瘤细胞率为54.0±30.3和46.2±36.3%,分别(P=.608)。使用Franseen针的单次通过样品进行分子检测的成功率分别为85.7%和Lancet针的57.1%。无严重并发症报告。
    结论:与柳叶刀针相比,Franseen针倾向于显示更大量的肿瘤细胞性标本,这可能有助于更高的分子检测成功率。必须进行进一步的研究以验证本研究的结果。
    结果:什么是已知的,什么是新的?含义是什么,现在应该改变什么?
    BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been used to diagnose and stage lung cancer. Acquire™ Pulmonary and Expect™ Pulmonary dedicated EBUS-TBNA needles were introduced as the Franseen and Lancet needles, respectively. It is still unclear whether the Franseen or Lancet needles yield a higher quality specimen especially focusing on next-generation sequencing-based molecular testing.
    METHODS: A single-center, prospective study performed at the Chiba University Hospital randomly assigned patients to two groups: Group A, wherein the first and second EBUS-TBNA were performed using Lancet and Franseen needles, respectively, and Group B, wherein the first and second EBUS-TBNA were performed using Franseen and Lancet needles, respectively. Each specimen was compared and analyzed pathologically. The primary outcome was the histological tissue area except blood clot and the cellularity of each sample. We also examined the success rate of molecular testing.
    RESULTS: Twelve patients who underwent EBUS-TBNA between November 2022 and February 2023 were enrolled in this study. The tissue area of the specimens obtained by the Franseen and Lancet needles was 13.3 ± 6.4 mm2 and 10.6 ± 6.3 mm2, respectively (P = .355). The tumor cellularity in the specimens obtained using the Franseen and Lancet needles was 54.0 ± 30.3 and 46.2 ± 36.3%, respectively (P = .608). The success rate of molecular testing using the single-pass sample by Franseen needle was 85.7 and 57.1% by Lancet needle. No serious complications were reported.
    CONCLUSIONS: The Franseen needle tended to show a greater amount of specimen with higher tumor cellularity than the Lancet needle which may contribute higher success rate of molecular testing. Further studies must be conducted to validate the results of this study.
    RESULTS: What is known and what is new?  What is the implication, and what should change now?
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  • 文章类型: Case Reports
    诺卡氏菌病是一种机会性感染,这种情况很少发生,主要发生在免疫缺陷患者中。即使病人有免疫能力,它仍然可能危及生命。此病例报告描述了一位先前健康的78岁男性农民,在计算机断层扫描中发现了肺部病变。结合患者的发热史和与炎症相关的实验室标志物升高的结果,病人被诊断为肺部感染。在逐步增加经验性广谱抗生素之后,抗病毒和抗真菌治疗,患者继续恶化为感染性休克。同时,病人的痰液反复培养,未发现明显的病原菌阳性。考虑到患者是老年人,这些病变是坚实的,有毛刺迹象,以及抗菌治疗后的进展,鉴别诊断中也考虑了癌症.人工智能(YITU,杭州一图医疗科技有限公司)也被申请,它还计算出这些病变是癌性的。患者接受了最大肺部病变的穿刺活检。在穿刺过程中,脓液从最大的肺部病变中取出。在脓液上进行的培养和宏基因组下一代测序(mNGS)检测表明诺卡氏菌。mNGS的测试报告还附有该诺卡氏菌属的常用临床抗生素的敏感性报告。使用这个结果,选择靶向药物复方磺胺甲恶唑和静脉注射美罗培南治疗后,患者病情迅速得到控制。鉴于诺卡氏菌的误诊率高,培养敏感性差。,该病例强调mNGS在诺卡氏菌属的诊断和选择有效的抗生素治疗中起关键作用。肺部感染。
    Nocardia disease is an opportunistic infection, the occurrence is rare and mostly occurs in patients with immune deficiency. Even if the patient is immunocompetent, it can still be life-threatening. This case report describes a previously healthy 78-year-old male farmer with lung lesions discovered on a computerized tomography scan. Combined with the patient\'s history of fever and the results of elevated laboratory markers associated with inflammation, the patient was diagnosed with a lung infection. After escalating empirical broad-spectrum antibiotics, antiviral and antifungal therapy, the patient continued to deteriorate to septic shock. In the meanwhile, the patient\'s sputum was cultured repeatedly, and no obvious positive pathogenic bacteria were found. Considering the patient was elderly and that these lesions were solid with burr signs, as well as the progression after antimicrobial therapy cancer was considered in the differential diagnosis. Artificial intelligence (YITU, Hangzhou Yitu Medical Technology Limited Company) was also applied, and it also calculated that these lesions were cancerous. The patient received a puncture biopsy of the largest lung lesion. During the puncture pus was withdrawn from largest lung lesion. Culture and metagenome next-generation sequencing (mNGS) detection performed on pus indicated Nocardia otitidiscaviarum. The test report of the mNGS is also attached with a susceptibility report of commonly used clinical antibiotics to this Nocardia spp. Using this result, the patient\'s disease was quickly controlled after selecting the targeted drug compound sulfamethoxazole and intravenous meropenem for treatment. In view of the high misdiagnosis rate and poor sensitivity of culture for Nocardia spp., this case emphasized mNGS playing a key role in the diagnosis and selection of effective antibiotics for the treatment of Nocardia spp. lung infections.
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