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

Yue, Ruiming; Wu, Xiaoxiao; Li, Tianlong; Li, Chang; Huang, Xiaobo; Pan, Lingai

doi:10.3389/fmed.2021.686512

Cited by 25 publications

(16 citation statements)

References 24 publications

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“…Based on the mNGS, 88.2% of the PJP critically pediatric patients modified their initial antimicrobial therapy and simplify the use of antibiotics ; Trimethoprimsulfamethoxazole was not received in 82.4% of patients until the report of mNGS results. Our data and previous studies showed that mNGS is excellent for the early and precise treatment of PJP [41,42] . However, blind treatment is inappropriate only based on mNGS, since NGS technology cannot distinguish pathogens between colonization and infection.…”

Section: 5impact Of Mngs On Pjp Patients' Antimicrobial Therapysupporting

confidence: 80%

Metagenomic Next-Generation Sequencing for the Diagnosis of Pneumocystis jirovecii Pneumonia in Critically pediatric patients: A Retrospective Study

Chen

Liang

Wang

et al. 2022

Preprint

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Objective The aim of this study was to evaluate the effectiveness of metagenomic next-generation sequencing (mNGS) for the diagnosis of Pneumocystis jirovecii Pneumonia(PJP) in critically pediatric patients. Methods Seventeen critically pediatric patients with PJP and 60 patients diagnosed with non-PJP pneumonia who were admitted in pediatric intensive care unit between June 2018 to July 2021 were enrolled. Conventional methods and mNGS for detecting Pneumocystis jirovecii (P. jirovecii) were analyzed. The patients' demographics, comorbidities, laboratory parameters, treatments and 30-days mortality were compared. Results MNGS showed a satisfying diagnostic performance with a sensitivity of 100% in detecting P. jirovecii compared to Gomori Methenamine silver staining(5.9%) and serum (1,3)-β-D-glucan(86.7%). The diagnostic specifificity of mNGS for PJP was higher than that of serum BDG(56.7%). In PJP cohort, over one thirds' cases had mixed infections. Compared with survivors, non-survivors had higher stringently mapped read numbers(SMRNs) in BALF(P < 0.05), suggesting SMRNs may play a potential role in the severity of response. The detection for P. jirovecii by mNGS both in BALF and blood reached a concordance rate of 100%,and the SMRNs in the BALF were remarkably higher than that in blood samples. Initial antimicrobial treatment was modifified in 88.2% of PJP patients based on the mNGS results. Conclusion MNGS is a potential and efficient technology in diagnosing PJP and shows a satisfying performance in the detection of co-pathogens. Both blood and BALF samples for mNGS are suggested for the presumptive diagnosis of PJP.

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Section: 5impact Of Mngs On Pjp Patients' Antimicrobial Therapysupporting

confidence: 80%

Metagenomic Next-Generation Sequencing for the Diagnosis of Pneumocystis jirovecii Pneumonia in Critically pediatric patients: A Retrospective Study

Chen

Liang

Wang

et al. 2022

Preprint

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“…The growth in the popularity of whole-genome sequencing techniques reflects their high diagnostic potential, and they are becoming increasingly affordable. Recent studies also demonstrate their value for microbial identification and in epidemiological studies [ 72 – 74 ].…”

Section: Diagnosis Of Legionnaires’ Diseasementioning

confidence: 99%

Legionnaires’ Disease: Update on Diagnosis and Treatment

et al. 2022

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Legionellosis is the infection caused by bacteria of the genus Legionella , including a non-pneumonic influenza-like syndrome, and Legionnaires’ disease is a more serious illness characterized by pneumonia. Legionellosis is becoming increasingly important as a public health problem throughout the world; although it is an underreported disease, studies have consistently documented a high incidence. In addition, health costs associated with the disease are high. Diagnosis of Legionnaires’ disease is based mainly on the detection of Legionella pneumophila serogroup 1 antigen in urine. However, there have been advances in detection tests for patients with legionellosis. New methodologies show greater sensitivity and specificity, detect more species and serogroups of Legionella spp., and have the potential for use in epidemiological studies. Testing for Legionella spp. is recommended at hospital admission for severe community-acquired pneumonia, and antibiotics directed against Legionella spp. should be included early as empirical therapy. Inadequate or delayed antibiotic treatment in Legionella pneumonia has been associated with a worse prognosis. Either a fluoroquinolone (levofloxacin or moxifloxacin) or a macrolide (azithromycin preferred) is the recommended first-line therapy for Legionnaires’ disease; however, little information is available regarding adverse events or complications, or about the duration of antibiotic therapy and its association with clinical outcomes. Most published studies evaluating antibiotic treatment for Legionnaires’ disease are observational and consequently susceptible to bias and confounding. Well-designed studies are needed to assess the usefulness of diagnostic tests regarding clinical outcomes, as well as randomized trials comparing fluoroquinolones and macrolides or combination therapy that evaluate outcomes and adverse events.

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“…The specimen from bronchoalveolar lavage fluid (BALF), blood, and urine was negative for infection, as well as for specific anti-Legionella antibodies. Nevertheless, the L. mNGS identification of BALF and blood proved to be the only method that allowed for the detection of L. pneumophila [ 137 ]. Although the radiological diagnosis of pneumonia includes a chest X-ray and computed tomography [ 138 ], pneumonia due to Legionella spp.…”

Section: Diagnosis Of Legionella Diseasesmentioning

confidence: 99%

Legionella pneumophila: The Journey from the Environment to the Blood

Iliadi

Staykova

Iliadis

et al. 2022

JCM

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An outbreak of a potentially fatal form of pneumonia in 1976 and in the annual convention of the American Legion was the first time that Legionella spp. was identified. Thereafter, the term Legionnaires’ disease (LD) was established. The infection in humans is transmitted by the inhalation of aerosols that contain the microorganisms that belong to the Legionellaceae family and the genus Legionella. The genus Legionella contains genetically heterogeneous species and serogroups. The Legionella pneumophila serogroup 1 (Lp1) is the most often detected strain in outbreaks of LD. The pathogenesis of LD infection initiates with the attachment of the bacterial cells to the host cells, and subsequent intracellular replication. Following invasion, Legionella spp. activates its virulence mechanisms: generation of specific compartments of Legionella-containing vacuole (LCV), and expression of genes that encode a type IV secretion system (T4SS) for the translocation of proteins. The ability of L. pneumophila to transmigrate across the lung’s epithelium barrier leads to bacteremia, spread, and invasion of many organs with subsequent manifestations, complications, and septic shock. The clinical manifestations of LD depend on the bacterial load in the aerosol, the virulence factors, and the immune status of the patient. The infection has two distinct forms: the non- pneumatic form or Pontiac fever, which is a milder febrile flu-like illness, and LD, a more severe form, which includes pneumonia. In addition, the extrapulmonary involvement of LD can include heart, brain, abdomen, and joints.

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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

Cited by 25 publications

References 24 publications

Metagenomic Next-Generation Sequencing for the Diagnosis of Pneumocystis jirovecii Pneumonia in Critically pediatric patients: A Retrospective Study

Metagenomic Next-Generation Sequencing for the Diagnosis of Pneumocystis jirovecii Pneumonia in Critically pediatric patients: A Retrospective Study

Legionnaires’ Disease: Update on Diagnosis and Treatment

Legionella pneumophila: The Journey from the Environment to the Blood

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