Empyema caused by Eikenella halliae diagnosed by metagenomic next-generation sequencing (mNGS) after pulmonary surgery: A case report

Abstract

BackgroundEmpyema is one of the complications of pulmonary surgery for lung cancer, the incidence of which is not very high, but in severe cases, it can even lead to death, and it is always difficult to diagnose the cause by conventional methods.Case presentationIn this study, we report a clinical case of empyema caused by Eikenella halliae after pulmonary surgery in a 55-year-old man. He had a fever, cough, and expectoration for 3 days and was diagnosed with right hydropneumothorax and empyema, pneumonia, postoperative malignant tumor of the right lower lobe (adenocarcinoma), and hypertension. The microbiology laboratory reported Gram-negative bacteria in pleural effusion, which was preliminarily considered as Eikenella based on culture and 16S rRNA sequencing. Furthermore, metagenomic next-generation sequencing (mNGS) of sputum samples was performed two times and reported negative results and the presence of E. halliae, respectively. The pathogen was finally confirmed as E. halliae by whole genome sequencing, suggesting the high-resolution ability of mNGS in the clinical diagnosis of this case.ConclusionTo our knowledge, this is the first case report of E. halliae infection in China, indicating increased pathogenicity of Eikenella sp. in immunocompromised patients, especially after invasive operations. Our findings emphasize that mNGS allows bacterial diagnosis of empyema and can significantly improve the accuracy of the diagnosis.

Literature Review of Pathogen Agnostic Molecular Testing of Clinical Specimens From Difficult-to-Diagnose Patients: Implications for Public Health

“… 3 , 17 , 38 , 47 Researchers used mNGS to detect single pathogens, 18 , 24 , 26 , 33 , 34 multiple pathogens, 29-31 , 39 , 48 , 42 and rare pathogens. 22 , 28 Results from mNGS were also used to correlate with clinical symptoms, 42 test specimens from patients with atypical or no symptoms, 21 , 40 , 49 and facilitate more accurate 28 and improved clinical care. 50 Additionally, mNGS analyses yielded several significant detection advantages, including detection from a very ill or immunocompromised patient, 13 , 19 , 20 when all other advanced tests and cultures performed were negative 27 , 32 , 33 , 35 , 50 or inconclusive.…”