Deng ZF, Tang YJ, Yan CY, Qin ZQ, Yu N, Zhong XB. Pulmonary nocardiosis with bloodstream infection diagnosed by metagenomic next-generation sequencing in a kidney transplant recipient: A case report. World J Clin Cases 2023; 11(7): 1634-1641 [PMID: 36926398 DOI: 10.12998/wjcc.v11.i7.1634]
Corresponding Author of This Article
Xiong-Bo Zhong, MD, Doctor, Department of Urology Surgery, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, No. 10 Huadong Road, Nanning 530011, Guangxi Zhuang Autonomous Region, China. zhongxb3560@163.com
Research Domain of This Article
Infectious Diseases
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Zhen-Feng Deng, Zi-Qian Qin, Ning Yu, Clinical Genome Center, Guangxi KingMed Diagnostics, Nanning 530007, Guangxi Zhuang Autonomous Region, China
Yan-Jiao Tang, Graduate School, Guangxi University of Chinese Medicine, Nanning 530001, Guangxi Zhuang Autonomous Region, China
Chun-Yi Yan, Department of Organ Transplantation, No. 923 Hospital of Chinese People's Liberation Army, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Xiong-Bo Zhong, Department of Urology Surgery, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning 530011, Guangxi Zhuang Autonomous Region, China
Author contributions: Deng ZF contributed to manuscript writing and editing and data analysis; Tang YJ and Yan CY were responsible for the clinical care of the patient and data collection; Qin ZQ interpreted the metagenomic next-generation sequencing reports; Yu N implemented and monitored the metagenomic next-generation sequencing experiments; Zhong XB designed the report and oversaw patient management; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiong-Bo Zhong, MD, Doctor, Department of Urology Surgery, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, No. 10 Huadong Road, Nanning 530011, Guangxi Zhuang Autonomous Region, China. zhongxb3560@163.com
Received: December 17, 2022 Peer-review started: December 17, 2022 First decision: January 17, 2023 Revised: January 28, 2023 Accepted: February 13, 2023 Article in press: February 13, 2023 Published online: March 6, 2023 Processing time: 75 Days and 5.3 Hours
Abstract
BACKGROUND
Pulmonary nocardiosis is difficult to diagnose by culture and other conventional testing, and is often associated with lethal disseminated infections. This difficulty poses a great challenge to the timeliness and accuracy of clinical detection, especially in susceptible immunosuppressed individuals. Metagenomic next-generation sequencing (mNGS) has transformed the conventional diagnosis pattern by providing a rapid and precise method to assess all microorganisms in a sample.
CASE SUMMARY
A 45-year-old male was hospitalized for cough, chest tightness and fatigue for 3 consecutive days. He had received a kidney transplant 42 d prior to admission. No pathogens were detected at admission. Chest computed tomography showed nodules, streak shadows and fiber lesions in both lung lobes as well as right pleural effusion. Pulmonary tuberculosis with pleural effusion was highly suspected based on the symptoms, imaging and residence in a high tuberculosis-burden area. However, anti-tuberculosis treatment was ineffective, showing no improvement in computed tomography imaging. Pleural effusion and blood samples were subsequently sent for mNGS. The results indicated Nocardia farcinica as the major pathogen. After switching to sulphamethoxazole combined with minocycline for anti-nocardiosis treatment, the patient gradually improved and was finally discharged.
CONCLUSION
A case of pulmonary nocardiosis with an accompanying bloodstream infection was diagnosed and promptly treated before the dissemination of the infection. This report emphasizes the value of mNGS in the diagnosis of nocardiosis. mNGS may be an effective method for facilitating early diagnosis and prompt treatment in infectious diseases, which overcomes the shortcomings of conventional testing.
Core Tip: Nocardiosis is challenging to diagnosis due to its infrequency in clinical practice, non-specificity in clinical presentation and imaging, and the limitations of detection methods. This report highlighted the value of metagenomic next-generation sequencing (mNGS) in the rapid and precise diagnosis of nocardiosis and underscores the limitations of conventional testing. mNGS may be an effective method for early diagnosis and prompt treatment of infectious diseases.
