Jiang Juan, Bai Lu, Yang Wei, Peng Wenzhong, An Jian, Wu Yanhao, Pan Pinhua, Li Yuanyuan
Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China.
Hunan Provincial Clinical Research Center for Respiratory Diseases, Changsha, People's Republic of China.
Infect Dis Ther. 2021 Sep;10(3):1733-1745. doi: 10.1007/s40121-021-00482-y. Epub 2021 Jul 10.
This study aimed to evaluate the utility of metagenomic next-generation sequencing (mNGS) for the diagnosis of Pneumocystis jirovecii pneumonia (PJP) in non-human immunodeficiency virus-infected patients.
We conducted a retrospective study. A total of 60 non-human immunodeficiency virus-infected PJP patients and 134 patients diagnosed with non-PJP pneumonia were included. P. jirovecii and other co-pathogens identified by mNGS in bronchoalveolar lavage fluid and/or blood samples were analyzed. Using clinical composite diagnosis as the reference standard, we compared the diagnostic performance of mNGS in PJP with conventional methods, including Gomori methenamine silver staining and serum (1,3)-β-D-glucan. Modifications of antimicrobial treatment for PJP patients after the report of mNGS results were also reviewed.
mNGS reached a sensitivity of 100% in diagnosing PJP, which was remarkably higher than Gomori methenamine silver staining (25.0%) and serum (1,3)-β-D-glucan (67.4%). The specificity of mNGS (96.3%) significantly surpassed serum (1,3)-β-D-glucan (81.4%). Simultaneous mNGS of bronchoalveolar lavage fluid and blood samples was performed in 21 out of 60 PJP patients, and it showed a concordance rate of 100% in detecting P. jirovecii. Besides, mNGS showed good performance in identifying co-pathogens of PJP patients, among which cytomegalovirus and Epstein-Barr virus were most commonly seen. Initial antimicrobial treatment was modified in 71.7% of PJP patients after the report of mNGS results.
mNGS is a useful diagnostic tool with good performance for the diagnosis of PJP and the detection of co-pathogens. mNGS of bronchoalveolar lavage fluid and/or blood samples is suggested in patients with presumptive diagnosis of PJP. Blood samples may be a good alternative to bronchoalveolar lavage fluid for mNGS when bronchoscopic examination is not feasible.
本研究旨在评估宏基因组下一代测序（mNGS）在诊断非人类免疫缺陷病毒感染患者的耶氏肺孢子菌肺炎（PJP）中的应用价值。
我们进行了一项回顾性研究。共纳入60例非人类免疫缺陷病毒感染的PJP患者和134例诊断为非PJP肺炎的患者。分析支气管肺泡灌洗液和/或血液样本中通过mNGS鉴定出的耶氏肺孢子菌及其他合并病原体。以临床综合诊断为参考标准，我们将mNGS对PJP的诊断性能与传统方法进行比较，传统方法包括Gomori六胺银染色和血清（1,3）-β-D-葡聚糖检测。还回顾了mNGS结果报告后PJP患者抗菌治疗方案的调整情况。
mNGS诊断PJP的敏感性达到100%，显著高于Gomori六胺银染色（25.0%）和血清（1,3）-β-D-葡聚糖检测（67.4%）。mNGS的特异性（96.3%）明显高于血清（1,3）-β-D-葡聚糖检测（81.4%）。60例PJP患者中有21例同时对支气管肺泡灌洗液和血液样本进行了mNGS检测，在检测耶氏肺孢子菌方面显示出100%的一致率。此外，mNGS在鉴定PJP患者的合并病原体方面表现良好，其中巨细胞病毒和EB病毒最为常见。mNGS结果报告后，71.7%的PJP患者调整了初始抗菌治疗方案。
mNGS是一种有用的诊断工具，在诊断PJP和检测合并病原体方面具有良好性能。对于疑似PJP的患者，建议对支气管肺泡灌洗液和/或血液样本进行mNGS检测。当支气管镜检查不可行时，血液样本可能是mNGS检测替代支气管肺泡灌洗液的良好选择。
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