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[1]周丽娟,邱玉英,曹孟淑,等.基于宏基因组二代测序诊断的肺诺卡菌病临床分析[J].医学研究与战创伤救治(原医学研究生学报),2023,25(2):122-128.[doi:10.3969/j.issn.1672-271X.2023.02.003]
　ZHOU Lijuan,QIU Yuying,CAO Mengshu,et al.Clinical analysis of pulmonary nocardiosis diagnosed by metagenomic next-generation sequencing[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2023,25(2):122-128.[doi:10.3969/j.issn.1672-271X.2023.02.003]
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基于宏基因组二代测序诊断的肺诺卡菌病临床分析()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第25卷
期数:
2023年2期
页码:
122-128
栏目:
临床研究
出版日期:
2023-05-31

文章信息/Info

Title:
Clinical analysis of pulmonary nocardiosis diagnosed by metagenomic next-generation sequencing
作者:
周丽娟; 邱玉英; 曹孟淑; 张英为; 代静泓; 黄妹; 曹敏; 张之烽; 肖永龙; 李燕
作者单位：210008南京，南京大学医学院附属鼓楼医院呼吸与危重症医学科（周丽娟、邱玉英、曹孟淑、张英为、代静泓、黄妹、曹敏、肖永龙、李燕），检验科（张之烽）
Author(s):
ZHOU Lijuan1;  QIU Yuying1;  CAO Mengshu1;  ZHANG Yingwei1;  DAI Jinghong1;  HUANG Mei1;  CAO Min1;  ZHANG Zhifeng2;  XIAO Yonglong1;  LI Yan1
(1.Department of Respiratory and Critical Care Medicine, 2.Department of Clinical Laboratory, Drum Tower Hospital Affiliated to Medical School of Nanjing University，Nanjing 210008, Jiangsu, China)
关键词:
诺卡菌; 肺诺卡菌病; 宏基因组二代测序
Keywords:
nocardia;  pulmonary nocardiosis;  metagenomic next-generation sequencing
分类号:
R519.1
DOI:
10.3969/j.issn.1672-271X.2023.02.003
文献标志码:
A
摘要:
目的为临床医师诊治肺诺卡菌病提供参考，并探讨宏基因组二代测序技术（mNGS）对肺诺卡菌病的临床诊断价值。方法对2017年1月至2022年10月南京大学医学院附属鼓楼医院通过mNGS检测诊断的13例肺诺卡菌患者进行回顾性分析，并进行相关文献复习。结果13例患者中，男9例，女4例，年龄35~79岁，平均（57±10）岁；10例伴有基础疾病，4例使用激素或免疫抑制剂。临床表现主要为咳嗽、咳痰、发热、气喘、咯血、消瘦等。胸部CT表现为结节、肺实变、胸膜增厚、空洞、肿块、胸腔积液、支气管扩张、纵隔及腋窝淋巴结肿大、磨玻璃影。通过经支气管镜肺泡灌洗液行mNGS检测确诊9例，经支气管镜肺活检组织行mNGS检测确诊1例，经皮肺穿刺活检组织行mNGS检测确诊3例，标本均未培养出诺卡菌。入院至确诊中位时间为8 d（3.50~15.00 d）。治疗药物以复方磺胺甲噁唑为主，分别联合利奈唑胺、阿米卡星、亚胺培南、美罗培南、莫西沙星等抗菌药物。11例随访病情好转，1例随访无好转，3个月后确诊为肺癌，1例自动出院，未继续治疗。结论肺诺卡菌病的临床表现及影像学无明显特异性，容易漏诊、误诊。肺诺卡菌感染可能合并其他潜在病因，需密切随访以免漏诊。相较于传统细菌培养法，mNGS对于肺诺卡菌病是一种敏感高效的诊断方法，有很好的应用前景。
Abstract:
ObjectiveTo provide reference for clinicians in the diagnosis and treatment of pulmonary nocardiosis, and to investigate the clinical diagnostic value of metagenomic next-generation sequencing (mNGS) in pulmonary nocardiosis.MethodsFrom January 2017 to October 2022, thirteen patients with pulmonary nocardiosis diagnosed by mNGS detection in Drum Tower Hospital Affiliated to Medical School of Nanjing University were retrospectively analyzed, and review relevant literature.ResultsAmong thirteen patients with pulmonary nocardiosis, there were nine males and four females, aged 35-79 years old, with an average of (57±10) years old. Ten patients had comorbidities, four patients were treated with hormone or immunosuppressant. The main clinical manifestations were cough, expectoration, fever, asthma, hemoptysis and emaciation. The manifestations of chest CT scans included nodules, consolidation, pleural thickening, cavity, masses, pleural effusion, bronchiectasis, mediastinal and axillary lymph node enlargement and ground glass opacity. Nine cases were confirmed by mNGS using bronchoalveolar lavage fluid, one case was confirmed by mNGS using tissue acquired by transbronchial lung biopsy and three cases were confirmed by mNGS using tissues acquired by CT guided percutaneous lung biopsy, nocardia was not cultured in all samples. The median time from admission to diagnosis was 8 days (3.50-15.00 days). The therapeutic drugs were mainly compound sulfamethoxazole combined with linezolid, amikacin, imipenem, meropenem, moxifloxacin and other antibacterial drugs. Eleven patients were followed up for improvement, one patient was not improved and was diagnosed with lung cancer after three months of follow-up, one patient was discharged automatically without continuing treatment.ConclusionThe clinical manifestations and CT imaging features of pulmonary nocardiosis are nonspecific and easy to be missed and misdiagnosed. Pulmonary nocardiosis may be associated with other potential causes, so close follow-up is needed to avoid missed diagnosis. Compared to the traditional bacterial culture method, mNGS is a sensitive and efficient diagnostic method for pulmonary nocardiosis, which has a promising application prospect.

参考文献/References:

[1]Kandi V. Human Nocardia infections: a review of pulmonary nocardiosis[J]. Cureus, 2015, 7(8):e304. doi: 10.7759/cureus.304..
[2]Wang S, Chen Y, Wang D, et al. The feasibility of metagenomic next-generation sequencing to identify pathogens causing tuberculous meningitis in cerebrospinal fluid[J]. Front Microbiol，2019，10:1993. doi: 10.3389/fmicb.2019.01993.
[3]章辉,罗嫚,王娇莉.白塞病合并肺奴卡菌病一例报道并文献复习[J].浙江中西医结合杂志,2021,31(11):1046-1049.
[4]刘美红,贺环宇,李艳霞,等.宏基因组二代测序技术诊断快速进展肺奴卡菌病1例[J].现代医药卫生,2022,38(12):2149-2152.
[5]王传海,李霜,张建,等.肺奴卡菌病合并曲霉感染2例并文献复习[J].中国感染控制杂志,2022,21(10):1019-1025.
[6]伍春霞,陈亚娟.肺泡蛋白沉积症合并肺诺卡菌病一例[J].临床内科杂志,2022,39(6):422-423.
[7]周磊,李海峰,李略.肺豚鼠耳炎诺卡菌病一例报告[J].现代实用医学,2020,32(10):1292-1293，1304.
[8]沈轶,张海,李锋,等.豚鼠耳炎诺卡菌肺病一例并文献复习[J].国际呼吸杂志,2020,40(12):897-903.
[9]安袁笑雪,杜以明,田甜,等.肺炎奴卡菌合并天美奴卡菌肺部感染1例报道并文献复习[J].山东大学学报(医学版),2022,60(3):59-63，70.
[10]李维,邹慧敏,亚白柳,等.脑脊液二代测序诊断诺卡菌致多发脑脓肿1例[J].中国神经精神疾病杂志,2021,47(2):106-108.
[11]Yan H, Li Z, Xia H, et al. A case report on mixed pulmonary infection of Nocardia nova, Mycobacterium tuberculosis, and Aspergillus fumigatus based on metagenomic next-generation sequencing[J]. Front Public Health，2022，10:927338. doi: 10.3389/fpubh.2022.927338.
[12]Chen YY, Xue XH. Coinfection of Streptococcus suis and Nocardia asiatica in the human central nervous system: A case report[J]. World J Clin Cases，2022，10(18):6283-6288.
[13]Luu T, Khalid R, Rehman T, et al. Disseminated Nocardia paucivorans Infection Resembling Metastatic Disease in a Kidney Transplant Recipient[J]. Cureus， 2022，14(5):e25365.doi: 10.7759/cureus.25365.
[14]Peng Y, Dong X, Zhu Y, et al. A rare case of pulmonary nocardiosis comorbid with Sjogren’s syndrome[J]. J Clin Lab Anal，2021，35(9):e23902. doi: 10.1002/jcla.23902.
[15]Hou J, Cao J, Tan P, et al. Pneumocystis jiroveci pneumonia, Nocardia brasiliensis, and Mycobacterium tuberculosis co-infection ina myasthenia gravis patient: A case report[J]. Medicine (Baltimore)，2021，100(1):e24245.doi: 10.1097/MD.0000000000024245.
[16]Rawat D, Rajasurya V, Chakraborty RK, et al. Nocardiosis[M]//StatPearls [Internet]. Stat Pearls Publishing, 2021.
[17]Zhong C, Huang P, Zhan Y, et al. Clinical Features of Pulmonary Nocardiosis in Patients with Different Underlying Diseases: A Case Series Study[J].Infect Drug Resist, 2022, 15: 1167-1174.
[18]Lynch JP 3rd, Reid G, Clark NM. Nocardia spp.: A Rare Cause of Pneumonia Globally[J]. Semin Respir Crit Care Med，2020，41(4):538-554.
[19]Liu B, Zhang Y, Gong J, et al. CT findings of pulmonary nocardiosis: a report of 9 cases[J]. J Thorac Dis, 2017, 9(11): 4785-4790.
[20]Steinbrink J, Leavens J, Kauffman CA, et al. Manifestations and outcomes of nocardia infections: comparison of immunocompromised and nonimmunocompromised adult patients[J]. Medicine, 2018, 97(40):e12436.doi: 10.1097/MD.0000000000012436.
[21]Chavez TT, Fraser SL, Kassop D, et al. Disseminated Nocardia cyriacigeorgica presenting as right lung abscess and skin nodule[J]. Mil Med, 2011, 176(5): 586-588.
[22]夏玉朝, 杨萱, 班立芳, 等. 10 例奴卡菌感染病例的临床特点及治疗[J]. 中国感染控制杂志, 2017, 16(5): 453-457.
[23]Zhou H, Larkin PMK, Zhao D, et al. Clinical Impact of Metagenomic Next-Generation Sequencing of Bronchoalveolar Lavage in the Diagnosis and Management of Pneumonia: A Multicenter Prospective Observational Study[J].J Mol Diagn, 2021, 23(10): 1259-1268.
[24]张彬,张弦,赵华,等.宏基因组学二代测序在不明原因发热患者病原体检测中的应用[J].交通医学,2020,34(2):131-135.
[25]Parize P, Muth E, Richaud C, et al. Untargeted next-generation sequencing-based first-line diagnosis of infection in immunocompromised adults: a multicentre, blinded, prospective study[J].Clin Microbiol Infect，2017，23(8):574.e1-574.e6.
[26]Margalit I, Muhsen K, Ben Ari Y, et al. Nocardia colonization in contrast to nocardiosis: a comparison of patients’ clinical characteristics[J].Eur J Clin Microbiol Infect Dis, 2020, 39(4): 759-763.
[27]Fujita T, Ikari J, Watanabe A, et al. Clinical characteristics of pulmonary nocardiosis in immunocompetent patients[J].J Infect Chemother，2016, 22(11): 738-743.
[28]Gilbert DN，Chambers HF，Eliopoulos GM，等.热病:桑德福抗微生物治疗指南[M].新译第48版.北京：中国协和医科大学出版社，2018:42.
[29]Wilson JW. Nocardiosis: updates and clinical overview[C]//Mayo Clinic Proceedings. Elsevier, 2012, 87(4): 403-407.

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备注/Memo

备注/Memo:
基金项目：江苏省自然科学基金面上项目（BK20221168）；南京市卫生科技发展专项资金医药卫生科研课题（YKK22084）
更新日期/Last Update: 2023-07-24