{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T21:23:08Z","timestamp":1785532988154,"version":"3.56.0"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,9,26]],"date-time":"2022-09-26T00:00:00Z","timestamp":1664150400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p><jats:italic>Legionella<\/jats:italic> rarely causes hospital-acquired pneumonia (HAP), although it is one of the most common pathogens of community-acquired pneumonia. Hospital-acquired Legionnaires\u2019 disease, mainly occurring in immunocompromised patients, is often delayed in diagnosis with high mortality. The use of the metagenome Next-Generation Sequencing (mNGS) method, which is fast and unbiased, allows for the early detection and identification of microorganisms using a culture-independent strategy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case report<\/jats:title><jats:p>A 52-year-old male, with a past medical history of Goods syndrome, was admitted due to nephrotic syndrome. The patient developed severe pneumonia, rhabdomyolysis, and soft tissue infection after receiving immunosuppressive therapy. He did not respond well to empiric antibiotics and was eventually transferred to the medical intensive care unit because of an acute respiratory failure and septic shock. The patient then underwent a comprehensive conventional microbiological screening in bronchoalveolar lavage fluid (BALF) and blood, and the results were all negative. As a last resort, mNGS of blood was performed. Extracellular cell-free and intracellular DNA fragments of <jats:italic>Legionella<\/jats:italic> were detected in plasma and blood cell layer by mNGS, respectively. Subsequent positive results of polymerase chain reaction for <jats:italic>Legionella<\/jats:italic> in BALF and soft tissue specimens confirmed the diagnosis of disseminated Legionnaires\u2019 disease involving the lungs, soft tissue, and blood stream. The patient\u2019s condition improved promptly after a combination therapy of azithromycin and moxifloxacin. He was soon extubated and discharged from ICU with good recovery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Early recognition and diagnosis of disseminated Legionnaires\u2019 disease is challenging. The emergence and innovation of mNGS of blood has the potential to address this difficult clinical issue.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2022.955955","type":"journal-article","created":{"date-parts":[[2022,9,26]],"date-time":"2022-09-26T05:26:17Z","timestamp":1664169977000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["A case of disseminated Legionnaires\u2019 disease: The value of metagenome next-generation sequencing in the diagnosis of Legionnaires"],"prefix":"10.3389","volume":"9","author":[{"given":"Shan","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Yao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Weng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Du","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Min","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,9,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1016\/S0140-6736(15)60078-2","article-title":"Legionnaires\u2019 disease.","volume":"387","author":"Cunha","year":"2016","journal-title":"Lancet."},{"key":"B2","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1111\/tid.12201","article-title":"Cutaneous legionellosis: case report and review of the medical literature.","volume":"16","author":"Padrnos","year":"2014","journal-title":"Transpl Infect Dis."},{"key":"B3","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1146\/annurev-pathmechdis-012418-012751","article-title":"Clinical metagenomic next-generation sequencing for pathogen detection.","volume":"14","author":"Gu","year":"2019","journal-title":"Annu Rev Pathol."},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms9020291","article-title":"Legionellosis caused by non-Legionella pneumophila species, with a focus on Legionella longbeachae.","volume":"9","author":"Chambers","year":"2021","journal-title":"Microorganisms."},{"key":"B5","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1017\/s0950268800057745","article-title":"Nosocomial legionnaires\u2019 disease in England and Wales, 1980-92.","volume":"112","author":"Joseph","year":"1994","journal-title":"Epidemiol Infect."},{"key":"B6","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1111\/j.1445-5994.2011.02508.x","article-title":"Legionella pneumophila lung abscess associated with immune suppression.","volume":"41","author":"Guy","year":"2011","journal-title":"Intern Med J."},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-018-3378-0","article-title":"Disseminated extrapulmonary Legionella pneumophila infection presenting with panniculitis: case report and literature review.","volume":"18","author":"Chitasombat","year":"2018","journal-title":"BMC Infect Dis."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1419","DOI":"10.1007\/s10096-021-04172-y","article-title":"Community-acquired versus nosocomial Legionella pneumonia: factors associated with Legionella-related mortality.","volume":"40","author":"Dagan","year":"2021","journal-title":"Eur J Clin Microbiol Infect Dis."},{"key":"B9","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/j.jinf.2021.01.029","article-title":"Metagenomic next-generation sequencing for the diagnosis of suspected pneumonia in immunocompromised patients.","volume":"82","author":"Peng","year":"2021","journal-title":"J Infect."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1184","DOI":"10.1093\/clinchem\/hvac097","article-title":"Cell-Free DNA as biomarker for sepsis by integration of microbial and host information.","volume":"68","author":"Jing","year":"2022","journal-title":"Clin Chem."},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s11908-021-00755-0","article-title":"New microbiological techniques for the diagnosis of bacterial infections and sepsis in ICU including point of care.","volume":"23","author":"Peri","year":"2021","journal-title":"Curr Infect Dis Rep."},{"key":"B12","doi-asserted-by":"publisher","first-page":"e394","DOI":"10.1097\/CCM.0000000000003658","article-title":"Enhanced performance of next-generation sequencing diagnostics compared with standard of care microbiological diagnostics in patients suffering from septic shock.","volume":"47","author":"Grumaz","year":"2019","journal-title":"Crit Care Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1373\/jalm.2018.026120","article-title":"Metagenomics to assist in the diagnosis of bloodstream infection.","volume":"3","author":"Greninger","year":"2019","journal-title":"J Appl Lab Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1111\/mec.15740","article-title":"The masking effect of extracellular DNA and robustness of intracellular DNA in anaerobic digester NGS studies: a discriminatory study of the total DNA pool.","volume":"30","author":"Nagler","year":"2021","journal-title":"Mol Ecol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1125","DOI":"10.1111\/j.1469-0691.2007.01805.x","article-title":"Outbreak of Legionnaires\u2019 disease in immunosuppressed patients at a cancer centre: usefulness of universal urine antigen testing and early levofloxacin therapy.","volume":"13","author":"Gudiol","year":"2007","journal-title":"Clin Microbiol Infect."},{"key":"B16","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.idc.2016.10.003","article-title":"Legionnaire\u2019s disease and immunosuppressive drugs.","volume":"31","author":"Htwe","year":"2017","journal-title":"Infect Dis Clin North Am."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.955955\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,26]],"date-time":"2022-09-26T05:26:19Z","timestamp":1664169979000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.955955\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,26]]},"references-count":16,"alternative-id":["10.3389\/fmed.2022.955955"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2022.955955","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,26]]},"article-number":"955955"}}