Wang Dongsheng, Fang Shihua, Hu Xiaowen, Xu Qixia, Chu Xinmin, Mei Xiaodong, Xie Wang
Department of Pulmonary and Critical Care Medicine, Anhui Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
Front Microbiol. 2022 Jun 17;13:913405. doi: 10.3389/fmicb.2022.913405. eCollection 2022.
To explore the value of metagenomic next-generation sequencing (mNGS) in diagnosing pneumocystis jiroveciipneumonia (PJP) in the immunocompromised patients.
Data of 122 patients with PJP in an immunosuppressed state and 67 non-PJP patients were collected. The diagnostic efficacy of mNGS was compared with the conventional methods, including Gomori methenamine silver (GMS) staining and serum (1,3)-β-D-glucan (BDG). Changes of anti-microbial therapy for patients with PJP based on mNGS results were also reviewed.
The diagnostic sensitivity of mNGS to PJP was higher than that of GMS and BDG (100% vs. 15 and 74.5%, < 0.001). The diagnostic specificity (91.%) was lower than that of GMS (100%), and similar with BDG (89.6%). In addition to P. jirovecii, mNGS revealed co-pathogens like human β-herpesvirus 5, human γ-pesvirus 4, and some other opportunistic pathogens. The reads of mNGS were remarkably higher in BALF than in blood samples. Initial antimicrobial treatment was modified in 89.3% patients based on the mNGS results, and 74 cases (60.7%) were treated with anti- jirovecii therapy.
mNGS is highly efficient in diagnosing PJP and good at identifying pathogens in mixed infections.
探讨宏基因组下一代测序（mNGS）在免疫功能低下患者诊断耶氏肺孢子菌肺炎（PJP）中的价值。
收集122例处于免疫抑制状态的PJP患者和67例非PJP患者的数据。将mNGS的诊断效能与传统方法进行比较，传统方法包括戈莫里甲胺银（GMS）染色和血清（1,3）-β-D-葡聚糖（BDG）。还回顾了基于mNGS结果对PJP患者抗菌治疗的变化。
mNGS对PJP的诊断敏感性高于GMS和BDG（100%对15%和74.5%，<0.001）。诊断特异性（91.%）低于GMS（100%），与BDG（89.6%）相似。除耶氏肺孢子菌外，mNGS还发现了人β疱疹病毒5、人γ疱疹病毒4等共病原体以及其他一些机会性病原体。mNGS在支气管肺泡灌洗液（BALF）中的读数明显高于血样。基于mNGS结果，89.3%的患者调整了初始抗菌治疗，74例（60.7%）接受了抗耶氏肺孢子菌治疗。
mNGS在诊断PJP方面效率高，且善于识别混合感染中的病原体。
