mNGS协助诊断无焦痂型丛林斑疹伤寒1例

A case of scrub typhus without eschar diagnosed by metagenomic next-generation sequencing

摘要:

丛林斑疹伤寒是由恙虫病东方体感染引起的一种急性人畜共患传染病。临床表现为发热、皮疹、淋巴结肿大, 被叮咬部位出现特异性焦痂和溃疡是该病诊断的最主要依据, 没有焦痂和溃疡的患者往往很难识别。本文报告1例54岁男性患者, 以发热、淋巴结肿大及全身多个脏器损伤为主要临床表现, 因无特征性焦痂, 且经验性使用抗菌药物效果不佳, 给诊疗带来困难。病例标本送宏基因组二代测序(mNGS)明确病原体为恙虫病东方体。换用左氧氟沙星及阿奇霉素治疗后患者症状很快好转, 最终痊愈出院。mNGS已被证明比传统培养方法更敏感, 在早期诊断恙虫病方面优于传统临床方法, 尤其是对于没有典型焦痂的患者。

Abstract:

Scrub typhus is an acute zoonotic infectious disease caused by Orientia tsutsugamushi. The clinical manifestations of the disease are fever, rash, lymph node enlargement, the presence of specific eschar and ulcer at the bitten site are the most important basis for diagnosis of the disease, patients without eschar and ulcer are often difficult to be identified. This article reports a 54 year old male patient with fever, lymph node enlargement and multiple organ damage as the main clinical manifestations, whose diagnosis was difficult due to the absence of cha-racteristic scabs and poor curative effect of empirical use of antimicrobial agents. The pathogen was clearly identified as Orientia tsutsugamushi after metagenomic next-generation sequencing (mNGS). After treated with levofloxacin and azithromycin, patient's symptoms improved quickly, finally recovered and discharged from hospital. mNGS has been proved more sensitive than traditional culture methods, and superior to traditional clinical methods in early diagnosis of tsutsugamushi disease, especially for patients without typical eschar.