From: Direct-from-blood RNA sequencing identifies the cause of post-bronchoscopy fever
Demographics |  | 22 year old Caucasian female |
---|---|---|
Symptoms | Â | fevers, chills, nausea, poor appetite |
Vital signs | Blood pressure: | 107/57 |
Heart Rate: | 124 | |
Respiratory rate: | 22 | |
Oxygen saturation: | 96% room air | |
Physical Exam | Lung: | mild wheeze and scattered crackles |
otherwise, unremarkable | Â | |
Laboratory analysis | WBC: | 13.2 |
Hemoglobin: | 8.5 | |
Platelets: | 279 | |
Sodium: | 137 | |
Potassium: | 4.8 | |
BUN: | 14 | |
Creatinine: | 1.2 | |
Glucose: | 289 | |
Lactate: | 4.2 | |
Thyroid Panel*: | Within normal limits | |
ESR & CRP: | within normal limits | |
ANA Screen*: | Negative | |
Microbiology | Blood Culture: | no growth |
Urine Culture: | no growth | |
BAL Culture: | rare Mucoid Pseudomonas | |
 | rare MRSA | |
 | Aspergillus flavus present | |
CMV quantitative PCR*: | undetectable | |
EBV quantitative PCR*: | undetectable | |
Pathology | BAL biopsy: | no evidence of rejection or infection |
Radiology | Chest X-ray: | right lower lobe atelectasis |
CT scan chest: | Interval development of ground glass and dense airspace | |
 | opacities in the lateral basal segment of the right lower | |
 | lobe. Recent bronchoscopy with biopsy in this location. | |
Nasopharyngeal Swab | Collected using the BD Universal Transport System from BD Biosciences using routine procedures and analyzed by multiplex PCR (xTAG® Respiratory Viral Panel FAST v2) | |
RNA Sequencing | Total RNA was isolated from 2.5 mL of peripheral blood drawn directly into PAXgene Blood RNA stabilization tubes (BD Biosciences) using the PAXgene Blood miRNA Kit (Qiagen). Abundant Globin and ribosomal RNA transcripts were depleted using Globin-Zero Gold rRNA Removal Kit (Illumina, San Diego, CA, USA). RNA sequencing library preparation used NEBNext Ultra RNA Library Prep Kit for Illumina (NEB, Ipswich, MA, USA). The resulting library was sequenced on the Illumina HiSeq 4000 to produce at least 50 million reads in a 2X 150 bp paired end format. Sequences were deposited in the Sequence Read Archive under project PRJNA408161. |