European Journal of Clinical Microbiology & Infectious Diseases ( IF 3.7 ) Pub Date : 2023-03-30 , DOI: 10.1007/s10096-023-04586-w Xuan Zhang 1 , Huixin Chen 1 , Dongsheng Han 2, 3, 4 , Wei Wu 1
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Abstract
Rickettsia and Coxiella burnetii are zoonotic tick-borne pathogens that cause febrile illnesses in humans. Metagenomic next-generation sequencing (mNGS) is a new technology used to diagnose infectious diseases. However, clinical experience with applying the test to rickettsioses and Q fever is relatively limited. Therefore, this study aimed to explore the diagnostic performance of mNGS in detecting Rickettsia and C. burnetii. We retrospectively studied patients with rickettsioses or Q fever between August 2021 and July 2022. Peripheral blood mNGS and polymerase chain reaction (PCR) were performed for all patients. Clinical data were retrieved for analysis. Thirteen patients were included in this study (eleven confirmed cases and two suspected cases). Signs and symptoms included fever (13, 100%), rash (7, 53.8%), muscle soreness (5, 38.5%), headache (4, 30.8%), skin eschar (3, 23.1%), and disturbance of consciousness (2, 15.4%). In addition, eight patients (61.6%) had thrombocytopenia, ten (76.9%) had liver function impairment, and two (15.4%) had renal function impairment. The results of mNGS revealed seven patients with R. japonica (53.8%), five with C. burneti (38.5%), two with R. heilongjiangensis (15.4%), and one with R. honei (7.7%). PCR results were positive in 11 patients (84.6%). After receiving doxycycline-based treatment, 12 (92.3%) patients returned to a normal temperature within 72 h. All patients were discharged in better health. Therefore, mNGS can help diagnose Rickettsia and C. burnetii and shorten the diagnosis time, especially for patients with atypical clinical manifestations and unclear epidemiologic evidence of a tick bite or exposure.
中文翻译：
宏基因组下一代测序在立克次体和伯氏立克次体诊断中的临床应用
摘要
立克次体和Coxiella burnetii是人畜共患的蜱传病原体，可引起人类发热性疾病。宏基因组下一代测序（mNGS）是一种用于诊断传染病的新技术。然而，将该试验应用于立克次体病和 Q 热的临床经验相对有限。因此，本研究旨在探讨 mNGS 在检测立克次体和伯氏立克次体中的诊断性能. 我们回顾性研究了 2021 年 8 月至 2022 年 7 月期间患有立克次体病或 Q 热的患者。对所有患者进行了外周血 mNGS 和聚合酶链反应 (PCR)。检索临床数据用于分析。本研究共纳入 13 名患者（11 名确诊病例和 2 名疑似病例）。体征和症状包括发烧 (13, 100%)、皮疹 (7, 53.8%)、肌肉酸痛 (5, 38.5%)、头痛 (4, 30.8%)、皮肤焦痂 (3, 23.1%) 和意识障碍(2, 15.4%)。此外，8名（61.6%）患者出现血小板减少症，10名（76.9%）患者出现肝功能损害，2名（15.4%）患者出现肾功能损害。mNGS 的结果显示 7 名患者患有R. japonica (53.8%)，5 名患者患有C. burneti (38.5%)，2 名患者患有 R. japonica (53.8%)R. heilongjiangensis (15.4%)，和R. honei (7.7%)。11 例患者 (84.6%) 的 PCR 结果呈阳性。在接受以多西环素为基础的治疗后，12 名（92.3%）患者在 72 小时内恢复了正常体温。所有患者均健康出院。因此，mNGS可以帮助诊断立克次体和伯氏立克次体并缩短诊断时间，特别是对于临床表现不典型且蜱叮咬或暴露的流行病学证据不明确的患者。
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