海口市人民医院于2021年6月收治1例78岁男性因“反复咳嗽、咳痰、气促9 d,加重1 d”入院的患者。患者为农民,有常接触土壤史。入院后查体,双肺可闻及散在湿啰音;C反应蛋白97.61 mg/L;痰培养及血培养阴性;胸部CT示两肺多发团片影及渗出,右侧胸腔少量积液;床旁支气管镜检查示双肺上叶可见少量活动性出血,可见少许血块。按“肺部感染”予抗生素治疗,效果不佳。肺泡灌洗液检出粪类圆线虫,粪检可见大量粪类圆线虫,肺泡灌洗液宏基因组二代测序检出嗜肺军团菌序列587条、粪类圆线虫序列155条。诊断为肺部粪类圆线虫病并嗜肺军团菌肺炎,予阿苯达唑片（0.4 g,1次/d,7 d;0.4 g,2次/d,21 d）、左旋咪唑片（100 mg,1次/d,14 d）及阿奇霉素（0.5 g,1次/d,12 d）治疗。治疗45 d后患者病情好转,粪检粪类圆线虫阴性,胸部CT肺部炎性病灶明显吸收好转。1个月后门诊复查,未见复发。

A 78-year-old patient was admitted to Haikou People’s Hospital in June 2021 due to “recurrent cough, expectoration and shortness of breath for 9 days and aggravation for 1 day”. The patient is a farmer with a history of frequent soil contact. Wet rales can be heard in both lungsat admission examination. The C-reactive protein was 97.61 mg/L. Sputum culture and blood culture were negative. Chest CT showed multiple mass radiography and exudation in both lungs and a small effusion in the right pleural cavity. A small amount of active bleeding was observed in the upper lobes of both lungs, with a few visible blood clots during bedside tracheoscopy. The patient was initially treated with antibiotics in accordance with the “lung infection” treatment, which did not respond well. Alveolar lavage fluid examination revealed Strongyloides faecalis. Metagenomic sequencing revealed 587 genes of Legionella pneumophila and 155 genes of S. faecalis. Pulmonary strongyliasis and L. pneumophila infection were diagnosed. The patient was treated with albendazole tablets (0.4 g, quaque die, 7 d; 0.4 g, bis in die, 21 d), azithromycin tablets (100 mg, quaque die, 14 d) and levamisole tablets (0.5 g, quaque die, 12 d). The patient’s condition improved 45 days after the treatment. The chest CT showed pulmonary inflammatory lesions absorption improved significantly. One month later, no recurrence was found in the reexamination.