宏基因组二代测序辅助诊断军团菌病伴横纹肌溶解和急性肾损伤一例_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

杜娆 ¹ , 冯银合 ^1,2 , 黄基峰 ¹ , 汪钰滨 ¹ , 杨晓娅 ¹ ,  毛辉 ¹

1. ;
2. ;

Corresponding author：

毛辉, Email: merrymh@126.com

Keywords：

军团菌病; 宏基因组二代测序; 横纹肌溶解; 急性肾损伤

DOI：

10.7507/1671-6205.202201037

Video：

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目的加强临床医生对军团菌病多器官损害临床特点的认识，针对目前军团菌诊断的难点，重视宏基因组二代测序（metagenomic next-generation sequencing，mNGS）在本病诊断中的应用价值，以早期诊断与精准治疗，改善军团菌病患者的预后。方法分析 1 例经 mNGS 确诊的嗜肺军团菌病患者的临床特点、治疗过程及预后。结果患者男，61 岁，因“发热、咳嗽伴乏力 3 d”就诊。发病初期除呼吸道症状外，合并多系统症状。住院期间，在肺泡灌洗液及肺组织中，mNGS 检出嗜肺军团菌，结合临床特点诊断军团菌病。患者经有创呼吸、抗感染、血液透析、保肝等综合治疗后，最终顺利出院。结论对于病程短，以肺炎表现为主伴多器官受累的疾病，尤其伴肌酸激酶显著升高者应警惕军团菌感染可能。对于病情危重且少痰或无痰的患者，在缺少其他检测方法（如军团菌尿抗原）的情况下，可行纤维支气管镜取肺泡灌洗液或经皮肺穿刺取肺组织进行mNGS检查，以早期明确病原体。军团菌肺炎伴发横纹肌溶解和急性肾损伤时，及早予以针对病因及并发症的综合治疗有助于改善患者预后。

Citation： 杜娆, 冯银合, 黄基峰, 汪钰滨, 杨晓娅, 毛辉. 宏基因组二代测序辅助诊断军团菌病伴横纹肌溶解和急性肾损伤一例. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(5): 353-357. doi: 10.7507/1671-6205.202201037 Copy

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11.	Mérault N, Rusniok C, Jarraud S, et al. Specific real-time PCR for simultaneous detection and identification of Legionella pneumophila serogroup 1 in water and clinical samples. Appl Environ Microbiol, 2011, 77(5): 1708-1717.
12.	Murdoch DR. Diagnosis of Legionella infection. Clin Infect Dis, 2003, 36(1): 64-69.
13.	Rihs JD, Yu VL, Zuravleff JJ, et al. Isolation of Legionella pneumophila from blood with the BACTEC system: a prospective study yielding positive results. J Clin Microbiol, 1985, 22(3): 422-424.
14.	Gu W, Miller S, Chiu CY. Clinical metagenomic next-generation sequencing for pathogen detection. Annu Rev Pathol, 2019, 14: 319-338.
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16.	Li N, Cai Q, Miao Q, et al. High-throughput metagenomics for identification of pathogens in the clinical settings. Small Methods, 2021, 5(1): 2000792.
17.	Huang Y, Ma Y, Miao Q, et al. Arthritis caused by Legionella micdadei and Staphylococcus aureus: metagenomic next-generation sequencing provides a rapid and accurate access to diagnosis and surveillance. AnnTransl Med, 2019, 7(20): 589.
18.	Yi H, Fang J, Huang J, et al. Legionella pneumophila as cause of severe community-acquired pneumonia, China. Emerg Infect Dis, 2020, 26(1): 160-162.
19.	Wang Y, Dai Y, Lu H, et al. Case report: metagenomic next-generation sequencing in diagnosis of Legionella pneumophila pneumonia in a patient after umbilical cord blood stem cell transplantation. Front Med, 2021, 8: 643473.
20.	Yue R, Wu X, Li T, et al. Early Detection of Legionella pneumophila and Aspergillus by mNGS in a critically ill patient with Legionella pneumonia after extracorporeal membrane oxygenation treatment: case report and literature review. Front Med, 2021, 8: 686512.
21.	Cabral BMI, Edding SN, Portocarrero JP, et al. Rhabdomyolysis. Dis Mon, 2020, 66(8): 101015.
22.	Bosch X, Poch E, Grau JM. Rhabdomyolysis and acute kidney injury. N Engl J Med, 2009, 361(1): 62-72.
23.	Posner MR, Caudill MA, Brass R, et al. Legionnaires' disease associated with rhabdomyolysis and myoglobinuria. Arch Intern Med, 1980, 140(6): 848-850.
24.	Koufakis T, Gabranis I, Chatzopoulou M, et al. Severe Legionnaires' disease complicated by rhabdomyolysis and clinically resistant to moxifloxacin in a splenectomised patient: too much of a coincidence?. Case Rep Infect Dis, 2015, 2015.
25.	Vanholder R, Sever MS, Erek E, et al. Rhabdomyolysis. J Am Soc Nephrol, 2000, 11(8): 1553-1561.
26.	Al-Ismaili Z, Piccioni M, Zappitelli M. Rhabdomyolysis: pathogenesis of renal injury and management. Pediatr Nephrol, 2011, 26(10): 1781-1788.
27.	Petejova N, Martinek A. Acute kidney injury due to rhabdomyolysis and renal replacement therapy: a critical review. Crit Care, 2014, 18(3): 224.
28.	Shah A, Check F, Baskin S, et al. Legionnaires' disease and acute renal failure: case report and review. Clin Infect Dis, 1992, 14(1): 204-207.
29.	Patel H, Shelley P, Hatoum H. Hypertriglyceridemia and massive rhabdomyolysis in a patient with disseminated legionella. Respir Med Case Rep, 2021, 32: 101321.

1. Fraser DW, Tsai TR, Orenstein W, et al. Legionnaires' disease: description of an epidemic of pneumonia. N Engl J Med, 1977, 297(22): 1189-1197.
2. Burillo A, Pedro-Botet ML, Bouza E. Microbiology and epidemiology of Legionnaire's disease. Infect Dis Clin North Am, 2017, 31(1): 7-27.
3. Chahin A, Opal SM. Severe pneumonia caused by Legionella pneumophila: differential diagnosis and therapeutic considerations. Infect Dis Clin North Am, 2017, 31(1): 111-121.
4. Mulazimoglu L, Yu VL. Can Legionnaires disease be diagnosed by clinical criteria? A critical review. Chest, 2001, 120(4): 1049-1053.
5. Cunha BA, Burillo A, Bouza E. Legionnaires' disease. Lancet, 2016, 387(10016): 376-385.
6. Soni AJ, Peter A. Established association of legionella with rhabdomyolysis and renal failure: a review of the literature. Respir Med Case Rep, 2019, 28: 100962.
7. 王佳鑫, 于墨池, 陈愉. 军团菌感染致肺外表现及调控机制研究进展. 华西医学, 2021, 36(1): 8-13.
8. Avni T, Bieber A, Green H, et al. Diagnostic accuracy of PCR alone and compared to urinary antigen testing for detection of Legionella spp.: a systematic review. J Clin Microbiol, 2016, 54(2): 401-411.
9. Shimada T, Noguchi Y, Jackson JL, et al. Systematic review and metaanalysis: urinary antigen tests for Legionellosis. Chest, 2009, 136(6): 1576-1585.
10. Jarraud S, Descours G, Ginevra C, et al. Identification of legionella in clinical samples. Methods Mol Biol, 2013, 954: 27-56.
11. Mérault N, Rusniok C, Jarraud S, et al. Specific real-time PCR for simultaneous detection and identification of Legionella pneumophila serogroup 1 in water and clinical samples. Appl Environ Microbiol, 2011, 77(5): 1708-1717.
12. Murdoch DR. Diagnosis of Legionella infection. Clin Infect Dis, 2003, 36(1): 64-69.
13. Rihs JD, Yu VL, Zuravleff JJ, et al. Isolation of Legionella pneumophila from blood with the BACTEC system: a prospective study yielding positive results. J Clin Microbiol, 1985, 22(3): 422-424.
14. Gu W, Miller S, Chiu CY. Clinical metagenomic next-generation sequencing for pathogen detection. Annu Rev Pathol, 2019, 14: 319-338.
15. Wilson MR, Naccache SN, Samayoa E, et al. Actionable diagnosis of neuroleptospirosis by next-generation sequencing. N Engl J Med, 2014, 370(25): 2408-2417.
16. Li N, Cai Q, Miao Q, et al. High-throughput metagenomics for identification of pathogens in the clinical settings. Small Methods, 2021, 5(1): 2000792.
17. Huang Y, Ma Y, Miao Q, et al. Arthritis caused by Legionella micdadei and Staphylococcus aureus: metagenomic next-generation sequencing provides a rapid and accurate access to diagnosis and surveillance. AnnTransl Med, 2019, 7(20): 589.
18. Yi H, Fang J, Huang J, et al. Legionella pneumophila as cause of severe community-acquired pneumonia, China. Emerg Infect Dis, 2020, 26(1): 160-162.
19. Wang Y, Dai Y, Lu H, et al. Case report: metagenomic next-generation sequencing in diagnosis of Legionella pneumophila pneumonia in a patient after umbilical cord blood stem cell transplantation. Front Med, 2021, 8: 643473.
20. Yue R, Wu X, Li T, et al. Early Detection of Legionella pneumophila and Aspergillus by mNGS in a critically ill patient with Legionella pneumonia after extracorporeal membrane oxygenation treatment: case report and literature review. Front Med, 2021, 8: 686512.
21. Cabral BMI, Edding SN, Portocarrero JP, et al. Rhabdomyolysis. Dis Mon, 2020, 66(8): 101015.
22. Bosch X, Poch E, Grau JM. Rhabdomyolysis and acute kidney injury. N Engl J Med, 2009, 361(1): 62-72.
23. Posner MR, Caudill MA, Brass R, et al. Legionnaires' disease associated with rhabdomyolysis and myoglobinuria. Arch Intern Med, 1980, 140(6): 848-850.
24. Koufakis T, Gabranis I, Chatzopoulou M, et al. Severe Legionnaires' disease complicated by rhabdomyolysis and clinically resistant to moxifloxacin in a splenectomised patient: too much of a coincidence?. Case Rep Infect Dis, 2015, 2015.
25. Vanholder R, Sever MS, Erek E, et al. Rhabdomyolysis. J Am Soc Nephrol, 2000, 11(8): 1553-1561.
26. Al-Ismaili Z, Piccioni M, Zappitelli M. Rhabdomyolysis: pathogenesis of renal injury and management. Pediatr Nephrol, 2011, 26(10): 1781-1788.
27. Petejova N, Martinek A. Acute kidney injury due to rhabdomyolysis and renal replacement therapy: a critical review. Crit Care, 2014, 18(3): 224.
28. Shah A, Check F, Baskin S, et al. Legionnaires' disease and acute renal failure: case report and review. Clin Infect Dis, 1992, 14(1): 204-207.
29. Patel H, Shelley P, Hatoum H. Hypertriglyceridemia and massive rhabdomyolysis in a patient with disseminated legionella. Respir Med Case Rep, 2021, 32: 101321.

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宏基因组二代测序辅助诊断军团菌病伴横纹肌溶解和急性肾损伤一例

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