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
Legionella pneumophila can cause pneumonia, leading to severe acute respiratory distress syndrome (ARDS). Because of its harsh growth requirements, limited detection methods, and non-specific clinical manifestations, diagnosing Legionella pneumonia remains still challenging. Metagenomic next-generat...
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Published in | Frontiers in medicine Vol. 8; p. 686512 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Frontiers Media S.A
30.06.2021
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Subjects | |
Online Access | Get full text |
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Summary: | Legionella pneumophila
can cause pneumonia, leading to severe acute respiratory distress syndrome (ARDS). Because of its harsh growth requirements, limited detection methods, and non-specific clinical manifestations, diagnosing
Legionella
pneumonia remains still challenging. Metagenomic next-generation sequencing (mNGS) technology has increased the rate of detection of
Legionella
. This study describes a patient who rapidly progressed to severe ARDS during the early stage of infection and was treated with extracorporeal membrane oxygenation (ECMO). Although his bronchoalveolar lavage fluid (BALF) was negative for infection and his serum was negative for anti-
Legionella
antibody, mNGS of his BALF and blood showed only the presence of
Legionella pneumophila
(blood mNGS reads 229, BALF reads 656). After antibiotic treatment and weaning from ECMO, however, he developed a secondary
Aspergillus
and
Klebsiella pneumoniae
infection as shown by mNGS. Mechanical ventilation and antibiotic treatment were effective. A search of PubMed showed few reports of secondary
Aspergillus
infections after
Legionella
infection. Severe pneumonia caused by any type of pathogenic bacteria may be followed by
Aspergillus
infection, sometimes during extremely early stages of infection. Patients with severe pneumonia caused by
Legionella
infection should undergo early screening for secondary infections using methods such as mNGS, enabling early and precise treatment, thereby simplifying the use of antibiotics and improving patient prognosis. |
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Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1 Reviewed by: Beiwen Zheng, Zhejiang University, China; Xiawei Jiang, Zhejiang Chinese Medical University, China; Wanhong Yin, Sichuan University, China Edited by: Li Ang, First Affiliated Hospital of Zhengzhou University, China These authors have contributed equally to this work This article was submitted to Infectious Diseases - Surveillance, Prevention and Treatment, a section of the journal Frontiers in Medicine |
ISSN: | 2296-858X 2296-858X |
DOI: | 10.3389/fmed.2021.686512 |