A case report on mixed pulmonary infection of Nocardia nova, Mycobacterium tuberculosis, and Aspergillus fumigatus based on metagenomic next-generation sequencing

Abstract

BackgroundPulmonary infection is one of the common complications of long-term use of glucocorticoids. Severe infections not only increase the length of hospital stay and treatment costs but also cause progression or recurrence of the primary disease.Case descriptionHerein, we reported a case of mixed pulmonary infection secondary to glucocorticoid use. Rare pathogens such as Nocardia nova, Mycobacterium tuberculosis, Aspergillus fumigatus, and cytomegalovirus were detected by metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid and lung puncture tissue. Combining the results of conventional pathogen detection and clinical symptoms, the patient was diagnosed with mixed pulmonary infection by multiple pathogens. After timely targeted medication, the patient was finally discharged with a good prognosis.ConclusionTo our knowledge, this is the first case report on mixed pulmonary infection with pathogens including Nocardia nova, Mycobacterium tuberculosis, Aspergillus fumigatus, and human cytomegalovirus. As a new clinical diagnostic method, mNGS has great advantages in diagnosis of diseases such as mixed infections.

Life-threatening pulmonary coinfection with Mycobacterium tuberculosis and Aspergillus lentulus in a diabetic patient diagnosed by metagenome next-generation sequencing

“…Pulmonary TB and aspergillosis have similar clinical symptoms including fever, chest tightness, shortness of breath, cough, chest pain, sputum with blood streaks, weight loss, and night sweats [ 8 ]. Therefore, they might be misdiagnosed and mistreated in clinical practice, and a definitive diagnosis relies on etiological detection results.…”

“…Yan et al reported a case on mixed pulmonary infection of Nocardia nova , M. tuberculosis , and A. fumigatus based on mNGS. Although sputum and BALF were sent several times for smear and culture, only A. fumigatus was detected by culture [ 8 ]. Qin et al reported a case of mixed pulmonary infection with Corynebacterium striatum , Pseudomonas aeruginosa , Streptococcus pneumoniae , and Cryptococcus neoformans through mNGS , while microbial culture and immunological tests were all negative [ 12 ].…”

Nocardia cyriacigeorgica infection in a patient with repeated fever and CD4+ T cell deficiency: A case report

“…Nocardia widely exists in soil, saprophytes and sewage[ 12 ]. It is an obligate aerobic bacterium with positive Gram staining and weak acid-fast staining, which usually leads to opportunistic infection[ 13 , 14 ]. The susceptible population is mainly long-term use of corticosteroids or immunosuppressants, diabetes patients and broad-spectrum antibiotic maintenance patients[ 15 - 18 ].…”

Rare occurrence of pulmonary coinfection involving Aspergillus fumigatus and Nocardia cyriacigeorgica in immunocompetent patients based on NGS: A case report and literature review

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“…Jinlin G, [30] 2022 China/62/man Intracranial, pulmonary Recovered well Yan H, [31] 2022 China/57/Man Pulmonary Recovered well central nervous system sites. A majority (60%) of the patients demonstrated a substantial recovery posttreatment.…”