Rickettsiosis includes a diversity of culture-negative non-specific systemic infections. Laboratory diagnosis of rickettsiosis is often not easy. In this 12-month study, six patients with a variety of rickettsia infections of the spotted fever group, typhus group and scrub typhus were diagnosed directly or indirectly by metagenomic next-generation sequencing (mNGS). The patient with Japanese spotted fever was rapidly made when mNGS analysis of the patient’s blood revealed Rickettsia japonica sequences. For the two patients with Rickettsia felis chest infections, the bacterium was detected in the bronchoalveolar lavage of one case and lung biopsy of the other. Both patients had underlying malignancies, carcinoma of the breast and carcinoma of the lung respectively, and were on chemotherapy with immunosuppressive effect. For the remaining three patients who presented over a period of 13 weeks, all had fever, headache and the typical eschar. They also had increased serum transaminases and responded promptly to doxycycline. However, the Weil-Felix test results of all three patients were negative. Since we considered the three cases typical of rickettsiosis, we submitted their serum samples for mNGS analysis. Results showed that Orientia tsutsugamushi sequences were present in the serum of one case. In view of the positive mNGS results, we repeated the Weil-Felix test for the residual sera of all three patients and it revealed that those of the other two cases showed OX-19 titers of 1:640 and 1:160 respectively, inferring that these two patients probably had rickettsiosis of the typhus group. As for the patient positive for O. tsutsugamushi sequences, we also detected IgM for O. tsutsugamushi in the serum, which double confirmed that it was a case of scrub typhus. mNGS is an important molecular tool and can complement serology for laboratory diagnosis of rickettsiosis.

十二指肠贾第虫也称为蓝氏贾第鞭毛虫或肠贾第虫,是一种能够引起散发性或流行性腹泻的原虫类寄生虫,其主要寄生于人和某些哺乳类动物的小肠[1].高危人群包括婴幼儿、跨国被收养者、旅行者、免疫功能低下者和囊性纤维化患者.蓝氏贾第鞭毛虫病在卫生设施落后、水处理条件有限的地区尤其常见.世界范围内,十二指肠蓝氏贾第鞭毛虫是 5 岁以下儿童中腹泻的第三大病原体,仅次于轮状病毒和隐孢子虫,每年报道有 3 亿多例病例[2].

Although Q fever has been widely reported in the rural areas of China, there is a paucity of data on the epidemiology and clinical characteristics of this disease in large metropolitan cities. In this study, we profile the epidemiology and clinical manifestations of Q fever from a tertiary hospital in Shenzhen, a Southern Chinese metropolitan city with a large immigrant population from other parts of China. A total of 14 patients were confirmed to have Q fever during a nine-year-and-six-month period, five of whom were retrospectively diagnosed during case review or incidentally picked up because of another research project on unexplained fever without localizing features. Some patients had the typical exposure histories and clinical features, while a few other patients had rare manifestations of Q fever, including one with heart failure and diffuse intracapillary proliferative glomerulonephritis, a patient presenting with a spontaneous bacterial peritonitis-like syndrome, and another one with concomitant Q fever and brucellosis. Using a combination of clinical manifestation, inflammatory marker levels, echocardiographic findings and serological or molecular test results, nine, three and two patients were diagnosed to have acute, chronic and convalescent Q fever, respectively. Seven, five and two patients were diagnosed to have Q fever by serological test, nested real-time PCR and next-generation sequencing respectively. Diverse and atypical manifestations are associated with Q fever. The incidence of Q fever is likely to be underestimated. Next-generation sequencing is becoming an important diagnostic modality for culture-negative infections, particularly those that the physicians fail to recognize clinically, such as Q fever.

目的 通过对胆汁涂片镜检法发现27例华支睾吸虫病的病例进行临床分析,总结胆汁涂片镜检法在华支睾吸虫病的诊断经验,为华支睾吸虫防控提供思路.方法 回顾性分析香港大学深圳医院2018年1月至2021年5月通过胆汁涂片镜检法发现的27例华支睾吸虫病患者的临床表现、实验室检查、影像学检查及治疗经过.结果16例(59.26％)患者有进食生鱼或者生虾史,临床主诉主要是右上腹隐痛或不适、皮肤黄染、发热等;大多数患者的肝功能、嗜酸性粒细胞值及C-反应蛋白正常,人院及术中诊断、影像学检查均未提示华支睾吸虫感染,术中留取胆汁行胆汁涂片镜检法发现华支睾吸虫卵后补充诊断,并给予驱虫治疗.结论 肝胆系统疾病患者行手术治疗时,建议常规留取胆汁行胆汁涂片镜检法查虫卵或寄生虫,可有效提高对华支睾吸虫病及其他寄生虫的诊断,减少漏诊.

目的 分析耶氏肺孢子菌肺炎的临床特征和实验室检测结果,为临床早期诊断和治疗提供依据.方法 回顾性分析2017年1月至2020年5月深圳某综合医院耶氏肺孢子菌的检出和临床分布情况、影像学特征、生化指标,以及六铵银染色检查的注意事项.结果 共检出6例耶氏肺孢子菌感染,患者年龄14～59岁,来源于ICU、血液内科、儿科等科室,主要临床诊断为白血病或肾炎.血清(I-3)-β-D-葡聚糖和乳酸脱氢酶均升高.染色温度和时间对六镀银染色的结果影响较大.影像学表现以胸部CT均发现磨玻璃密度影为主,患者经过复方新诺明和糖皮质激素联合治疗,症状有不同程度改善.结论 患有不明原因肺炎的白血病或肾炎患者,常规治疗无效的,应考虑耶氏肺孢子菌感染;六铵银染色法是一种检测耶氏肺孢子菌快速、简便的方法,应注意控制染色温度和时间.