宏基因二代测序技术对肝脓肿病原学诊断的价值

目的:探讨宏基因二代测序(metagenomics next-generation sequencing,mNGS)技术对肝脓肿病原学诊断的价值。方法:前瞻性纳入2020年2月至2021年4月复旦大学附属中山医院急诊科收治的35例肝脓肿患者,采用常规微生物培养法和mNGS技术分别检测血液和脓肿引流液样本。并将患者按是否出现休克分为两组,采用SPSS 25.0进行统计学分析,对比分析两组患者之间的差异。结果:mNGS技术在血液样本和引流液样本中总体检测阳性率显著高于常规培养法(血液：67.6% vs. 15.2%, P<0.05;引流液：100% vs. 55.2%, P<0.05)。35例肝脓肿病例中71.4%检出致病病原体为肺炎克雷伯菌。休克组患者脓肿引流液样本中mNGS检测出的致病病原体序列数显著高于非休克组( P<0.05)。 结论:mNGS能够快速准确的检测出肝脓肿的致病病原体,为临床精准治疗提供重要的病原学依据。     

侵袭性肺炎克雷伯菌肝脓肿综合征临床及影像学特点

目的 观察侵袭性肺炎克雷伯菌肝脓肿综合征（IKLAS）的临床及影像学特点。方法 回顾性分析18例IKLAS的临床及影像学表现。结果 临床表现为发热（18例）、寒战（11例），部分伴呼吸、消化、神经系统症状及视觉障碍；13例合并糖尿病；实验室感染指标增高，肝功能异常。肝脓肿位于肝右叶15例，肝左叶2例，同时累及肝左右叶1例；脓肿大小2.45~10.27 cm，平均（5.70±2.35）cm；3例为含气脓肿。双肺病灶分布以外周胸膜下为主，CT表现包括无空洞结节（18/18，100%）、空洞性结节（15/18，83.33%）、蜂窝脓肿（13/18，72.22%）、晕征（4/18，22.22%）、反晕征（3/18，16.67%）、实变影（3/18，16.67%）、外周楔形影（2/18，11.11%）、滋养血管征（2/18，11.11%）、磨玻璃影（1/18，5.56%）及双侧胸腔积液（15/18，83.33%）。2例合并颅内及眼部感染。结论 IKLAS影像学表现具有一定特征性，结合临床有助于诊断。     

宏基因二代测序技术辅助诊断波氏假阿利什霉肺部感染1例报告

假阿利什霉属肺部感染影像学表现与曲霉属感染无明显差异,但药物敏感性不同,因此菌种鉴定对指导临床治疗意义重大。本研究报告1例有哮喘病史的老年女性病例,出现咳嗽、咳痰伴胸闷,影像学表现为肺部空洞,经痰微生物培养和宏基因二代测序技术诊断为波氏假阿利什霉感染。国内外尚无宏基因二代测序技术诊断此疾病相关报道,该病例旨在为其在肺部感染的诊治提供参考。     

A clinical survey of<Emphasis Type="Italic">Klebsiella pneumoniae</Emphasis> virulence and genotype in pyogenic liver abscess

PrimaryKlebsiella pneumoniae liver abscess with metastatic complications is a globally emerging infectious disease and is the leading cause of liver abscess in Taiwan. Host immunity and bacterial virulence, especially of the capsular polysaccharide type, are important in determining clinical manifestations. Investigators retrospectively studied theK pneumoniae genotype and capsular serotype from patients with 37 strains of liver abscess; no correlation was noted with genotype, and many genetically different strains caused liver abscess. AlthoughK pneumoniae is prevalent in patients with diabetes, it can attack healthy or alcoholic people as well. Additional studies are needed to explore the mechanisms of bacterial virulence and to optimize treatment strategies. Physicians should be alert to the illness and its complications.     

肺炎克雷伯菌肝脓肿微生物学特征和耐药情况分析

目的探讨肺炎克雷伯菌肝脓肿患者的临床特征,以及肺炎克雷伯菌的微生物学特征和耐药情况。方法收集110例肺炎克雷伯菌肝脓肿患者的临床资料,分为有其他肝胆疾病组和无其他肝胆疾病组进行研究,采用黏液丝试验确定肺炎克雷伯菌的高黏液性状,采用PCR扩增法进行毒力基因检测及荚膜分型,选用纸片扩散法进行药敏试验,并对结果进行统计学分析。结果肺炎克雷伯菌肝脓肿常见于40~80岁的中老年男性,50.00%患者有糖尿病基础。110株肺炎克雷伯菌中,86.36%的菌株具有高黏液表型,荚膜分型以K1、K2血清型为主。无其他肝胆疾病组高黏液表型菌株、携毒力基因rmpA及气杆菌素的检出率明显高于有其他肝胆疾病组,差异有统计学意义(P0.01)。肺炎克雷伯菌对12种常见的抗菌药物的耐药率均较低。结论肺炎克雷伯菌肝脓肿常见于中老年男性,高黏液、携带毒力基因rmpA和气杆菌素的高毒力肺炎克雷伯菌是肝脓肿的主要病原菌,对常见抗菌药物的耐药率较低。     

双肺肺炎克雷伯杆菌感染合并肝脓肿及颅内多发脓毒性脑梗死1例

<正>患者男,71岁,头晕、乏力伴腹痛、腹泻及偶发胸痛不适6天,无发热;既往高血压病史8年。查体:体温38.2℃,脉搏114次/分,呼吸23次/分,血压148/87 mm Hg,左上腹压痛。实验室检查:总胆红素31.30μmol/L,直接胆红素21.00μmol/L,γ-谷氨酰转肽酶89.0 U/L,尿素13.07 mmol/L,肌酐165.2μmol/L,尿酸635.0μmol/L。颅脑及胸、腹部平扫CT:桥脑及双侧放射冠区见多发腔隙性脑梗死;     

Left eye enucleation caused by multi-systemic Klebsiella pneumoniae invasive syndrome

Klebsiella pneumoniae is generally considered the most common pathogenic bacterium causing community-acquired pneumonia. In recent years, cases of liver abscess caused by the bacterium and its spread have been reported in Asia and other parts of the world. This clinical symptom of liver abscess caused by hypervirulent K. pneumoniae and its migrating infection is also called invasive K. pneumoniae liver abscess syndrome (IKPLAS). This study explored the clinical characteristics, diagnosis, and treatment of an elderly patient with IKPLAS who experienced multi-organ failure caused by the infection. The treatment of the patient was difficult, and despite our efforts, the invasive infection led to eye enucleation. This paper is expected to improve our understanding and awareness of this disease in the clinic.     

Bloodstream infections caused by carbapenemase-producing Klebsiella pneumoniae: a clinical perspective

Dissemination of carbapenemase-producing Klebsiella pneumoniae (CP-Kp) has caused a public health crisis that can be paralleled with that caused by the spread of MRSA. CP-Kps, being multidrug-resistant, mainly affect patients with severe underlying conditions in the acute-healthcare setting. CP-Kps are responsible for a variety of life-threatening infections including bacteremia and pneumonia. The shortage of therapeutic options has forced clinicians to use colistin as well as tigecycline, a novel bacteriostatic agent. Although both drugs are generally active in vitro against CP-Kps, therapeutic failures, especially in bacteremias, are quite common. The authors suggest here, after reviewing the literature, that use of the latter drugs should be re-assessed and optimized. The authors have also summarized experimental and clinical data indicating that exploitation of the pharmacokinetic/pharmacodynamic features of carbapenems may provide solutions in bloodstream infections caused by CP-Kps with low-level resistance to the latter drugs. Most importantly, there is evidence that monotherapy must be avoided.     

Sonographic findings of hepatic venous gas in association with spontaneous rupture of a Klebsiella pneumoniae liver abscess: a case report

Hepatic venous gas (HVG) is a very rare ultrasonic finding, and it is defined as abnormal accumulation of gas in the hepatic venous system. Various diseases can cause HVG, and femoral venous catheter is the most common cause. We, herein, present the case of a 79-year-old female patient with HVG that was caused by spontaneous rupture of a Klebsiella pneumoniae liver abscess. This was first found by bedside ultrasonography. On the basis of the blood culture results, imipenem–cilastatin and cefoperazone sulbactam were administered and the effect was acceptable. After 41 days of antibacterial and symptomatic treatment in the hospital, the patient had recovered well and was discharged. All of the previous reports on HVG have been summarized by thoroughly reviewing the previous published work. Overall, this is the first patient with HVG in association with spontaneous rupture of a K. pneumoniae liver abscess, and it might provide insights for future studies regarding the treatment of this disease.     

肺炎克雷伯菌致多发性肝脓肿患者的加强护理

目的总结肺炎克雷伯菌致多发性肝脓肿患者的成功抢救与加强护理。方法介绍2例危重患者的抢救配合、肝脓肿穿刺置管与手术切开冲洗引流护理、肺炎克雷伯菌感染特点与预防交叉感染、高热护理、用药护理、基础护理、营养支持、心理护理、出院指导等。结果 2例患者经加强护理,完全康复出院。结论肺炎克雷伯菌是常见的多重耐药菌,其引起的多发性肝脓肿患者病情危重、病程长,加强监护、积极处理危及生命的症状和体征、尽早使用敏感抗菌药物、有效的脓肿切开引流、预防交叉感染是抢救成功的关键。     

宏基因二代测序技术指导下的皮肤炭疽院内感染防控1例报告

炭疽是一种由炭疽芽孢杆菌引起的人兽共患病,主要以皮肤炭疽为主,属于我国法定乙类传染病。本研究报告1例33岁男性病例,自述虫咬伤后出现右前臂皮疹,自行挑破后出现发红、水泡伴少量脓液,常规微生物培养结果为阴性,血宏基因二代测序(metagenomic next-generation sequencing,mNGS)结果示炭疽芽孢杆菌。本研究从早期诊断和指导院内感染防控角度,探讨mNGS的临床应用价值。     

Klebsiella pneumoniae invasion syndrome: a case of liver abscess combined with lung abscess,endophthalmitis, and brain abscess

Klebsiella pneumoniae invasion syndrome (KPIS) is a critical multi-site infection that is usually caused by highly virulent Klebsiella pneumonia. It is relatively common in Asian patients with diabetes and leads to sepsis, which has a high mortality rate. We report the case of a man in his early 40s who presented to the hospital with blurred vision in his left eye of 7 days’ duration and fever of 1 day’s duration. After a complete examination, he was diagnosed with KPIS on the basis of his liver abscessation, lung abscessation, endophthalmitis of the left eye and brain abscessation. After needle puncture and drainage of the left eye and liver abscess and anti-bacterial treatment with meropenem, the patient recovered well. When KPIS is suspected, attention should be paid to the sites of infection and the selection of the most appropriate antibiotics, but the most important aim should be to drain the lesions in a timely manner to improve the patient’s prognosis.     

Pyogenic liver abscess caused by Klebsiella pneumoniae genetic serotype K1 in Japan

Pyogenic liver abscess caused by Klebsiella pneumoniae is an emerging disease worldwide, and we know the serotype K1 strain to be the most virulent strain. We report a Japanese case of septic pyogenic liver abscess caused by K. pneumoniae genetic serotype K1. A 60-year old man presented at our hospital in a state of cardiopulmonary arrest. From the patient’s chief complaint of chest pain, we suspected acute coronary syndrome, i.e., acute myocardial infarction. We used extracorporeal circulation and checked coronary angiography, but the 75% stenosis by itself could not adequately account for the patient’s critical condition. The patient’s laboratory data indicated multiple organ failure. The patient’s condition did not improve while in intensive care and he died 20 h after the onset of the cardiopulmonary arrest. Pathological autopsy later showed colliquative necrosis in the deltoid and left greater pectoral muscles, as well as liver abscesses. The patient’s blood, gastric juice, and stool cultures all grew a Gram-negative bacillus identified as Klebsiella pneumoniae. We also performed capsular polysaccharide synthesis (cps) genotyping by polymerase chain reaction for the detection of K serotype-specific alleles at the wzx and wzy loci. The result indicated that wzx-K1 and wzy-K1 were positive. This is the first reported Japanese case of septic pyogenic liver abscess caused by K. pneumoniae genetic serotype K1.     

Recurrent pyogenic liver abscess after pancreatoduodenectomy caused by common hepatic artery injury: A case report

BACKGROUNDPancreaticoduodenectomy (PD) has been increasingly performed as a safe treatment option for periampullary malignant and benign disorders. However, the operation may result in significant postoperative complications. Here, we present a case that recurrent pyogenic liver abscess after PD is caused by common hepatic artery injury in atypical celiac axis anatomy.CASE SUMMARYA 56-year-old man with a 1-d history of fever and shivering was diagnosed with hepatic abscess. One year and five months ago, he underwent PD at a local hospital to treat chronic pancreatitis. After the operation, the patient had recurrent intrahepatic abscesses for 4 times, and the symptoms were relieved after percutaneous transhepatic cholangial drainage combining with anti-inflammatory therapy in the local hospital. Further examination showed that the recurrent liver abscess after PD was caused by common hepatic artery injury due to abnormal abdominal vascular anatomy. The patient underwent percutaneous drainage but continued to have recurrent episodes. His condition was eventually cured by right hepatectomy. In this case, preoperative examination of the patient’s anatomical variations with computed tomography would have played a pivotal role in avoiding arterial injuries.CONCLUSIONA careful computed tomography analysis should be considered mandatory not only to define the operability (with radical intent) of PD candidates but also to identify atypical arterial patterns and plan the optimal surgical strategy.     

A case of tick-transmitted Q fever in Lishui,China diagnosed by next-generation sequencing

Q fever is a zoonotic disease caused by Coxiella burnetii. Most patients have non-specific symptoms at onset. In addition, routine diagnostic tests for C. burnetii are not sensitive, and the bacterium cannot grow in general culture medium. The diagnosis of Q fever therefore poses a challenge. This case study describes a man with a clear history of tick bite who had recurrent fever, pneumonia, and liver damage. Routine tests and bacterial cultures failed to clarify the pathogeny, but laboratory and imaging data suggested infection. After routine tests were exhausted, we detected the presence of C. burnetii in a whole blood sample using next-generation sequencing (NGS). To our knowledge, this is the first report of Q fever associated with Coxiella burnetii detected directly from blood samples in Lishui, China. NGS has revolutionized the diagnosis of infectious diseases, especially those caused by rare or newly discovered pathogens, and patient responses have finally proved its substantial benefits. NGS has important clinical significance for the early diagnosis of chronic Q fever. This proof-of-concept study is worthy of promotion in clinical practice.