新生儿嗜肺军团菌肺炎2例

Two cases of neonatal Legionella pneumonia

摘要:

患儿1，女，12 d，因发热、咳嗽、呼吸困难、感染指标增高就诊，需呼吸支持治疗，血液及肺泡灌洗液宏基因组二代测序（metagenomic next-generation sequencing, mNGS）示嗜肺军团菌（Legionella pneumophila, LP），诊断为LP肺炎、LP败血症，予红霉素15 d、阿奇霉素5 d治疗痊愈出院。患儿2，女，11 d，因呼吸困难、发热、感染指标增高伴多器官功能损伤就诊，需机械通气，血及脑脊液mNGS示LP，诊断为LP肺炎、LP败血症、LP颅内感染，予红霉素19 d治疗痊愈出院。新生儿LP肺炎无特异临床症状，首选抗菌药物为阿奇霉素，对不明原因新生儿重症肺炎使用mNGS可早期明确诊断。

Abstract:

Patient 1, a 12-day-old female infant, presented with fever, cough, dyspnea, and elevated infection markers, requiring respiratory support. Metagenomic next-generation sequencing (mNGS) of blood and bronchoalveolar lavage fluid revealed Legionella pneumophila (LP), leading to diagnoses of LP pneumonia and LP sepsis. The patient was treated with erythromycin for 15 days and azithromycin for 5 days, resulting in recovery and discharge. Patient 2, an 11-day-old female infant, presented with dyspnea, fever, elevated infection markers, and multiple organ dysfunction, requiring mechanical ventilation. mNGS of blood and cerebrospinal fluid indicated LP, leading to diagnoses of LP pneumonia, LP sepsis, and LP intracranial infection. The patient was treated with erythromycin for 19 days and was discharged after recovery. Neonatal LP pneumonia lacks specific clinical symptoms, and azithromycin is the preferred antimicrobial agent. The use of mNGS can provide early and definitive diagnosis for severe neonatal pneumonia of unknown origin.