Clinical metagenomic sequencing for diagnosis of pulmonary tuberculosis

Shi, Cui-Lin; Han, Peng; Tang, Peijun; Chen, Mengmeng; Ye, Zhijian; M, Wu; Shen, Jie; Wu, Haiyan; Tan, Zhuqing; Yu, Xin; Rao, G. R.; Zhang, Jianping

doi:10.1016/j.jinf.2020.08.004

Cited by 85 publications

(75 citation statements)

References 27 publications

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“…Chest CT does not always show a typical miliary nodular pattern. Definitive diagnosis depends on the isolation of M. tuberculosis by culture or the identification of specific sequences of DNA by PCR or mNGS in related samples (9)(10)(11)(12). In the present case, the nucleic acid of M. tuberculosis complex in sputum and BALF was detected by PCR and mNGS, respectively.…”

Section: Discussionmentioning

confidence: 68%

Disseminated Tuberculosis Associated Hemophagocytic Lymphohistiocytosis in a Pregnant Woman With Evans syndrome: A Case Report and Literature Review

Shi

Zhang

et al. 2021

Front. Immunol.

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BackgroundTuberculosis (TB) is a leading cause of morbidity and mortality in underdeveloped and developing countries. Disseminated TB may induce uncommon and potentially fatal secondary hemophagocytic lymphohistiocytosis (HLH). Timely treatment with anti-tuberculosis therapy (ATT) and downmodulation of the immune response is critical. However, corticosteroid treatment for TB-associated HLH remains controversial. Herein, we report a successful case of disseminated TB-associated HLH in a pregnant woman with Evans syndrome accompanied by a literature review.Case PresentationA 26-year-old pregnant woman with Evans syndrome was transferred to the Third Affiliated Hospital of Sun Yat-Sen University because of severe pneumonia. She presented with cough, fever, and aggravated dyspnea. Nested polymerase chain reaction for Mycobacterium tuberculosis (M. tuberculosis) complex in sputum was positive. Sputum smear sample for acid-fast bacilli was also positive. Metagenome next-generation sequencing (mNGS) of the bronchoalveolar lavage fluid identified 926 DNA sequence reads and 195 RNA sequence reads corresponding to M. tuberculosis complex, respectively. mNGS of blood identified 48 DNA sequence reads corresponding to M. tuberculosis. There was no sequence read corresponding to other potential pathogens. She was initially administered standard ATT together with a low dose of methylprednisolone (40 mg/day). However, her condition deteriorated rapidly with high fever, acute respiratory distress syndrome, pancytopenia, and hyperferritinemia. Bone marrow smears showed hemophagocytosis. And caseating tuberculous granulomas were found in the placenta. A diagnosis of disseminated TB-associated HLH was made. Along with the continuation of four drug ATT regimen, therapy with a higher dose of methylprednisolone (160 mg/day) combined with immunoglobulin and plasma exchange was managed. The patient’s condition improved, and she was discharged on day 19. Her condition was good at follow-up with the continuation of the ATT.ConclusionsClinicians encountering patients with suspected TB accompanied by unexplainable inflammation not responding to ATT should consider complications with HLH. Timely administration of ATT combined with corticosteroids may result in a favorable outcome.

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Section: Discussionmentioning

confidence: 68%

Disseminated Tuberculosis Associated Hemophagocytic Lymphohistiocytosis in a Pregnant Woman With Evans syndrome: A Case Report and Literature Review

Shi

Zhang

et al. 2021

Front. Immunol.

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“…However, the sensitivity of both culture and Xpert MTB/RIF remains very low for the diagnosis of extrapulmonary tuberculosis. As a new laboratory method, next-generation sequencing (NGS) has been reported to be applied to assist the diagnosis of various pathogens, and in active pulmonary tuberculosis ( 19 , 26 ). Plenty of studies have confirmed that NGS is quick to detect M. tuberculosis complex in various samples, with its sensitivity and specificity similar to Xpert MTB/RIF ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Mycobacterium tuberculosis Septic Shock in Patients With Anti-synthetase Syndrome Based on Next-Generation Sequencing: A Case Report and Literature Review

Yang

Wang

et al. 2021

Front. Med.

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A 51-year-old woman was transferred to the intensive care unit with such symptoms as fever, swollen left knee joint, pain and hypotension. After preliminary evaluation, she was diagnosed as suffering acute suppurative arthritis and septic shock. Then, she was rescued and prescribed to receive treatment with broad-spectrum antibiotics. However, there was no source of infection identified except for the knee joint. The bacterial and fungal cultures of blood samples and articular effusion were shown to be negative, while the results obtained from the next-generation sequencing of blood and articular effusion revealed that Mycobacterium tuberculosis was positive. The patient was then put on five combinations of anti-tuberculosis therapeutic treatment. Nevertheless, despite the active anti-tuberculosis treatment put in place, her general condition still deteriorated progressively. As the level of her bilirubin continued to rise, further treatment was affected, which prompted the change made to the anti-tuberculosis treatment program. Her clinical condition continued to deteriorate, which led to the development of unstable vital signs and the multiple organ dysfunction syndrome. In spite of our best efforts to save her life, the patient still ended up with death.

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“…There are sporadic reports to date of clinical COVID-19 virus reactivation. Ye et al reported five patients with clinical reactivation presenting mostly with fatigue and fever, but none of them developed severe COVID-19 pneumonia or died [ 11 ]. Ravioli et al reported two elderly patients who developed COVID-19, recovered and tested negative by PCR, and then developed a new COVID-19 pneumonia, with one patient dying and the other remaining hospitalized at the time of the report [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Recurrent COVID-19 infection in a health care worker: a case report

et al. 2021

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Background Recurrent coronavirus disease 2019 (COVID-19) infection is an emerging problem and may prove to be one of the greatest problems in controlling the pandemic in the future. Recurrent infections can be due to reactivation of dormant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or reinfection with similar or different strains of SARS-CoV-2. Case presentation Here we present an interesting case of a health care worker working as a laboratory assistant at a COVID-19 laboratory who developed recurrent COVID-19 infection. He did not develop an immune response after the first episode of COVID-19; however, immunoglobulin G (IgG) antibodies were detected after the second episode. Conclusions Through this case, we discuss the concept of reactivation and reinfection in the post-COVID period. We suggest that standard guidelines should be established to check for viral shedding and immune response among cured cases of COVID-19 after discharge via serial real-time polymerase chain reaction (RT-PCR) testing and IgG antibody detection. Further, strict hygiene practices should be stressed to these patients with possibility of COVID-19 recurrence.

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Clinical metagenomic sequencing for diagnosis of pulmonary tuberculosis

Cited by 85 publications

References 27 publications

Disseminated Tuberculosis Associated Hemophagocytic Lymphohistiocytosis in a Pregnant Woman With Evans syndrome: A Case Report and Literature Review

Disseminated Tuberculosis Associated Hemophagocytic Lymphohistiocytosis in a Pregnant Woman With Evans syndrome: A Case Report and Literature Review

Diagnosis of Mycobacterium tuberculosis Septic Shock in Patients With Anti-synthetase Syndrome Based on Next-Generation Sequencing: A Case Report and Literature Review

Recurrent COVID-19 infection in a health care worker: a case report

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