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Case Report
Early diagnosis of Legionnaires’ pneumonia in an immunocompromised neuroblastoma patient using metagenomic next-generation sequencing: A case report
1 Department of Clinical Laboratory, Center for Laboratory Medicine, Hainan Women and Children’s Medical Center, Hainan Medical University, Haikou, Hainan 570206, China
2 Department of Microbiology, Faculty of Medicine-Lincoln University College, Petaling Jaya, Malaysia
3 Hainan Medical University-The University of Hong Kong Joint Laboratory of Tropical Infectious Diseases, Key Laboratory of Tropical Translational Medicine of Ministry of Education, School of Basic Medicine and Life Sciences, Hainan Medical University, Haikou, Hainan 571199, China
4 Respiratory Department, Northumbria Health Care NHS Foundation Trust, Care of Gail Hewitt, Newcastle NE23 6NZ, UK
5 Department of Pathogen Biology, Hainan Medical University, Haikou 571199, China
Address correspondence to:
Meng Chang
Department of Clinical Laboratory, Center for Laboratory Medicine, Hainan Women and Children’s Medical Center, Hainan Medical University, Haikou, Hainan 570206,
China
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Article ID: 101478Z01MX2024
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How to cite this article
Xiao M, Banu A, Zeng X, Shi S, Chen S, Ge N, Tang C, Huang Y, Wang G, Hu X, Cui X, Yin F, Peng R, Chang M. Early diagnosis of Legionnaires’ pneumonia in an immunocompromised neuroblastoma patient using metagenomic next-generation sequencing: A case report. Int J Case Rep Images 2024;15(2):89–95.ABSTRACT
Introduction: Legionella pneumophila (L. pneumophila) is an aerobic, Gram-negative intracellular pathogen commonly responsible for community-acquired pneumonia and a significant causative agent in hospital-acquired pneumonia. Immunocompromised individuals, such as those undergoing organ transplantation, chemotherapy, or corticosteroid therapy, are particularly vulnerable to L. pneumophila infections. These infections often lead to Legionnaires’ pneumonia, which is challenging to differentiate from other respiratory pathogen infections based solely on clinical presentation. Moreover, traditional pathogen detection methods have low sensitivity for Legionella, further complicating the diagnosis of Legionnaires’ pneumonia.
Case Report: This case report presents a 6-year-and-9-month-old boy who developed persistent high fever during chemotherapy following the surgical resection of a retroperitoneal neuroblastoma. Imaging studies revealed significant pneumonia manifestations. Metagenomic next-generation sequencing (mNGS) of nasopharyngeal swabs and bronchoalveolar lavage fluid confirmed the diagnosis of Legionnaires’ pneumonia.
Conclusion: This case highlights the challenges and critical importance of early and accurate diagnosis of Legionella infections, particularly in immunocompromised patients such as those undergoing chemotherapy. The use of advanced diagnostic techniques like metagenomic next-generation sequencing (mNGS) is essential for the prompt identification and treatment of Legionnaires’ pneumonia in this vulnerable population, improving patient outcomes. This report emphasizes the need for heightened awareness and advanced diagnostic techniques in managing atypical pneumonia pathogens in vulnerable populations.
Keywords: Immunocompromised patient, Legionella pneumophila, Legionnaires pneumonia, Metagenomic next-generation sequencing
SUPPORTING INFORMATION
Author Contributions
Meifang Xiao - Conception of the work, Design of the work, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Afreen Banu - Conception of the work, Design of the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Xiangyue Zeng - Acquisition of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Shengjie Shi - Acquisition of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Siqi Chen - Acquisition of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Nan Ge - Acquisition of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Cheng Tang - Acquisition of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Yi Huang - Acquisition of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Gaoyu Wang - Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Xiaoyuan Hu - Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Xiuji Cui - Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Feifei Yin - Conception of the work, Design of the work, Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Ruoyan Peng - Conception of the work, Design of the work, Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Meng Chang - Conception of the work, Design of the work, Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2024 Meifang Xiao et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
