| Description |
To explore the clinical application prospect of metagenomic next generation sequencing(mNGS) technology for pathogens combined with clinical dialectical thinking in the diagnosis and treatment of patients with fever of unknown origin. Methods: The clinical data of 34 cases of children with fever of unknown origin were collected from April 2019 to April 2021 in Guangzhou Women and Children's Medical Center, who were recieved pathogenic mNGS technology and traditional clinical examinations. The results of mNGS and traditional etiological and immunological examinations were compared, and the clinical diagnosis and treatment process with the clinical dialectical thinking was recorded. Results: Among the 34 cases, 20 cases were infected and 12 cases were not infected. The other 2 cases were still undiagnosed after examination. The clinical coincidence rate of mNGS results was 43.75%. There was no significant difference in the positive rate between mNGS and traditional clinical tests, but the positive rate of the combination of the two tests was up to 75%. 13 cases of mNGS sequencing were positive, and 5 of them were caused by Epstein-Barr virus, cytomegalovirus, circovirus and staphylococcus veroniferi. Based on clinical dialectical analysis of data, Epstein-Barr virus, cytomegalovirus and staphylococcus veroniferi were considered as background microorganisms, while Staphylococcus veroniferi as contamination bacteria. Three cases of mNGS were negative, but the background microorganisms included Actinomyces graevenitzii, Human alphaherpesvirus 1, and Mycobacterium gilvum, which were considered to be pathogenic microorganisms. Conclusions: The mNGS technology has great advantages in the detection of pathogens that cannot be defined by conventional clinical examinations. However, due to the interference of various factors, the clinical application value can only be improved by using dialectical thinking and comprehensive analysis combined with clinical data. |
