Metagenomic next-generation sequencing in the diagnosis of leptospirosis presenting as severe diffuse alveolar hemorrhage: a case report and literature review

Abstract

Background Leptospirosis is a common infectious disease in tropical and semitropical regions, and it is typically neglected. Leptospirosis-associated acute diffuse alveolar hemorrhage is one of its fatal complications. The use of bronchoalveolar lavage fluid (BALF) metagenomic next-generation sequencing in the diagnosis of Leptospira interrogans infection has rarely been reported. Case presentation We present the case of a 62-year-old female who was transferred to our hospital with dyspnea, and severe hemoptysis and was supported by a tracheal intubation ventilator. Bronchoalveolar lavage fluid (BALF) metagenomic next-generation sequencing (mNGS) reported Leptospira interrogans. A diagnosis of diffuse alveolar hemorrhage caused by leptospirosis was made. After immediately receiving antibiotics and hormone therapy, the patient achieved a complete recovery upon discharge. Conclusion Leptospirosis presenting as severe diffuse alveolar hemorrhage is rare but should be considered in the differential diagnosis. mNGS can help identify pathogens and treat them early, which can improve prognosis.

A rare case of severe leptospirosis infection presenting as septic shock in a non-epidemic area: A case report and literature review

“…Leptospira culture is an aetiological test with high speci city, and considered as the gold standard test for diagnosis [13,14] . However, it can take up to about 13 weeks and does not contribute early diagnosis of Leptospira [15] .Enzyme-linked immunosorbent assay (ELISA) for detecting IgM, IgG, or both antibody types have been developed to detect speci c antibodies in leptospirosis, while the method is prone to false-positive diagnosis [15,16] .As a complementary approach to conventional methods, mNGS is increasingly being applied in clinical laboratories for the diagnosis of leptospirosis, and can accurately detect Leptospira DNA during the early stage of the infection [15,17] . Early diagnosis of leptospirosis is crucial to provide early and appropriate empiric antibiotics.…”

The diagnosis of leptospirosis complicated by pulmonary tuberculosis complemented by metagenomic next-generation sequencing: A case report

“…Thus, misdiagnoses and underdiagnoses frequently occur. Independent of manifestation-based diagnoses, mNGS identifies microorganisms solely based on their sequence information, which provides it with great opportunities to unveil rare or even newly emergent pathogenic microorganisms as well as those involving coinfections or diseases with synonymous clinical symptoms, especially in comparison with conventional diagnostics ( Wang et al., 2019 ; Chen et al., 2021 ; Zhao et al., 2021 ). For example, a novel pathogenic strain of pseudorabies virus (hSD-1/2019) was for the first time identified from the CSF samples of four acute encephalitis patients with the application of mNGS ( Liu et al., 2021 ).…”

Application of metagenomic next-generation sequencing in cutaneous tuberculosis

“…The rest of the data were assembled using PMSEQ bioinformatics analysis software and classified via simultaneous alignment to the pathogen metagenomics database (PMDB) containing 17,500 pathogens. To date, the PMDB contains 10,989 bacterial genomes or scaffolds (196 Mycobacterium and 159 Mycoplasma, Chlamydia, and Rickettsia), 1,179 fungi related to human diseases, 5,050 whole-genome sequences of viral taxa, and 282 parasites associated with human infection (Chen et al, 2021;Yu et al, 2021;Ma et al, 2022).…”

“…In recent decades, metagenomic next-generation sequencing (mNGS) has emerged as a rapidly developing new technology for etiological diagnosis (Jacob et al, 2019;Guo et al, 2021). In some infectious diseases (e.g., blood infection, central nervous system infection, lung infection, or focal infection), mNGS plays an important role in etiological diagnosis, especially in the identification of MTBC and rare pathogens, such as mycoplasma, Chlamydia, parasite, and viruses (Bezerra et al, 2020;Haston et al, 2020;Yu et al, 2020;Chen et al, 2021;Jing et al, 2021).…”