A case report of the metagenomic next-generation sequencing for timely diagnosis of a traveler with nonspecific febrile Q fever
Qiaoli Xu,
Wenyan Han,
Yihua Cai,
Yuyao Yin,
Yifan Guo,
Hongbin Chen,
Hui Wang
Affiliations
Qiaoli Xu
Department of Clinical Laboratory, Peking University People's Hospital, Beijing, 100044, China; Department of Clinical Laboratory, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, 363000, China
Wenyan Han
Department of Clinical Laboratory, Peking University People's Hospital, Beijing, 100044, China; Clinical Laboratory of the Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, 010020, China
Yihua Cai
Department of Clinical Laboratory, Peking University People's Hospital, Beijing, 100044, China; Medical Laboratory of the Third Affiliated Hospital of Shenzhen University, Guangdong, 518001, China
Yuyao Yin
Department of Clinical Laboratory, Peking University People's Hospital, Beijing, 100044, China
Yifan Guo
Department of Clinical Laboratory, Peking University People's Hospital, Beijing, 100044, China
Hongbin Chen
Department of Clinical Laboratory, Peking University People's Hospital, Beijing, 100044, China; Corresponding author. Department of Clinical Laboratory, Peking University People's Hospital, Number 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
Hui Wang
Department of Clinical Laboratory, Peking University People's Hospital, Beijing, 100044, China; Corresponding author. Department of Clinical Laboratory, Peking University People's Hospital, Number 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
Q fever is a worldwide distribution disease caused by Coxiella burnetii（C. burnetii）, an obligate intracellular, Gram-negative acidophilic bacterium belonging to γ-proteobacterium. Most patients present with acute Q-fever accompanied by atypical flu-like symptoms, with only 1%–5% of cases may develop into persistent and focally infected foci, mainly manifest as endocarditis, osteomyelitis and prosthetic arthritis. In this case, the patient experienced an unexplained and uninterrupted fever up to 39.2 °C for a week, accompanied by chills and headaches, as well as abnormal liver function. The laboratory reported negative results for blood culture and respiratory-associated pathogens, however, the metagenomic next-generation sequencing (mNGS) reported that detection of 20 sequence reads of C. burnetii in the patient's peripheral blood. In addition, the patient had traveled to Sri Lanka, Iraq and Saudi Arabia before illness. In clinical, the treatment regimen was adjusted from empirically intravenous moxifloxacin 400 mg a day for 1 week to continuously oral minocyline 100 mg twice daily for 2 weeks. The patient was in good health without any adverse sequelae during outpatient visitation and the phone calls follow-up. In conclusion, the mNGS does provide an early and timely diagnostic basis for rare and difficult to culture pathogens, which contributes to the success of clinical anti-infection.
