PMC6761247_01
Timeline of the patient's clinical course and outcome. MEM, Meropenem; VA, Vancomycin; VOR, Voriconazole; TZP, Tazobactam and Piperacillin; TMP-SMX, Trimethoprim/Sulfamethoxazole.
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F1
Then intravenous fluids and meropenem were administered (Figure 1). Given the concern for a severe infection, empiric broad-spectrum antibiotics consisting of meropenem, vancomycin, and voriconazole to cover typical bacterial pathogens and fungal infection after a second infectious workup was performed including repeated blood culture, sputum culture (Figure 1).
Computer tomography imaging showing lung lesion. (A) CT of the chest obtained around the time of clinical presentation most severely, showing bilateral alveolar multiple patchy shadows and local consolidation, more prominent on the left lung than right. (B) CT of the chest obtained after treatment 14 days with TMP-SMX, showing absorption multiple patchy and local consolidation. (C) CT of the chest obtained around the time of 2 weeks after discharge from NICU, showing that dual markings slightly increased, the lung parenchyma was no significant consolidation.
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F2
Pulmonary atelectasis in the right upper lobe and bilateral alveolar consolidation by chest computed tomography on Day 6 after the onset of symptoms (Figure 2A). Her oxygenation status and chest computed tomography showed significant improvement after treatments (Figure 2B), and the infant was discharged on Day 30 after admission. Two weeks after discharge, the infant appeared good responses and appetite, and her chest computed tomography showed distribution of the two slightly thickened lung markings, clear lung fields and no substantive changes (Figure 2C).
Next-generation sequencing and a metagenomic analysis. (A)
Stenotrophomonas maltophilia specific reads and its nucleotide position along Stenotrophomonas maltophilia genome. (B)
Penicillium chrysogenum specific reads and its nucleotide position along Penicillium chrysogenum genome. (C)
Pichia anomala specific reads and its nucleotide position along Pichia anomala genome. (D)
Candida parapsilosis specific reads and its nucleotide position along Candida parapsilosis genome.
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F3
Stenotrophomonas maltophilia reads (428) were the only bacterial pathogen in blood (Figure 3A). In addition, we also detected several fungi pathogens in blood, including Penicillium chrysogenum reads (404), Pichia anomala reads (134), and Candida parapsilosis reads (Figures 3B-D).