使用多重巢式PCR方法來診斷退伍軍人症

Using the multiple nested PCR method for diagnosis of Legionnaires’disease

案例為一位出生9天大的雙胞胎新生兒突然發燒的病例報告。患者在月子中心接受照顧，突然發燒，沒有咳嗽、流鼻水、嘔吐或腹瀉的症狀，但活動和食慾下降。血液檢查顯示白血球增多和CRP升高，CXR顯示雙側肺野肺炎斑塊。流感、COVID-19、RSV和尿液GBS抗原檢測均為陰性。經使用多重巢式PCR，例如BioFire®FilmArray系列的腦膜炎／腦炎套組（ME）、呼吸道套組（RP）及肺炎套組（PN），依順序用於中樞神經系統和呼吸道感染中的病原體進行全面性檢測。患者在肺炎套組（PN）中被檢驗出退伍軍人菌（Legionella pneumophila）後，開始接受相應治療，最終順利出院。

Neonatal legionnaires’disease is rare and prompt diagnosis and treatment are crucial for favorable outcomes. One of the 9-day-old twins in a confinement center developed a high fever with poor appetite and decreased activities, but no signs of respiratory or gastrointestinal tract infections were found. Laboratory surveys and chest radiographs showed leukocytosis, elevated CRP, and patchy infiltration in both lungs; however, tests for influenza, COVID-19, RSV, and urinary group B streptococcal antigens were all negative. As pathogen-specific tests were limited in diagnostic power, syndromic multiplex PCR tests, such as the Biofire®FilmArray meningitis/encephalitis panel, respiratory panel, and pneumonia panels were sequentially used for a thorough survey of pathogens involved in CNS and respiratory tract infections. The patient was diagnosed with Legionella pneumophila infection by the pneumonia panel and treated accordingly, with full recovery.