A case report of the metagenomic next-generation sequencing for timely diagnosis of a traveler with nonspecific febrile Q fever
Abstract
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 of these diseases present as acute Q-fever with atypically flu-like symptoms, only 1%—5% of cases may develop into persistent and focally infected foci, mainly manifested as endocarditis, osteomyelitis and prosthetic arthritis. In this case, the patient experienced an unexplained and uninterrupted fever up to 39.2℃for a week, accompanied by chills and headaches, as well as abnormal liver function. And he has traveled to Sri Lanka, Iraq and Saudi Arabia before illness. The microbiology laboratory reported negative results for respiratory-associated pathogens and blood culture, however, the metagenomic next-generation sequencing (mNGS) reported that detection of 20 sequence reads of C.burnetii in the patients peripheral blood. 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, and without any adverse sequelae in a follow-up phone call. 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.
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