Zhu Shan, Liu Ying, Luo Hai-Yan, Yang Ming-Hua, Yang Liang-Chun, Deng Wen-Jun
Department of Pediatrics, Xiangya Hospital of Central South University, Changsha 410008, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2022 Jul 15;24(7):753-758. doi: 10.7499/j.issn.1008-8830.2204038.
To study the application value of metagenomic next-generation sequencing (mNGS) for pathogen detection in childhood agranulocytosis with fever.
A retrospective analysis was performed on the mNGS results of pathogen detection of 116 children with agranulocytosis with fever who were treated from January 2020 to December 2021. Among these children, 38 children with negative mNGS results were enrolled as the negative group, and 78 children with positive results were divided into a bacteria group (=22), a fungal group (=23), and a viral group (=31). Clinical data were compared between groups.
For the 116 children with agranulocytosis and fever, the median age was 8 years at diagnosis, the median turnaround time of mNGS results was 2 days, and the positive rate of mNGS testing was 67.2% (78/116). Compared with the negative group, the bacterial group had a higher procalcitonin level (<0.05), the fungal group had higher level of C-reactive protein and positive rate of (1,3)-β-D glucan test/galactomannan test (<0.05), and the fungal group had a longer duration of fever (<0.05). Among the 22 positive microbial culture specimens, 9 (41%) were consistent with the mNGS results. Among the 17 positive blood culture specimens, 8 (47%) were consistent with the mNGS results. Treatment was adjusted for 28 children (36%) with the mNGS results, among whom 26 were cured and discharged.
The mNGS technique has a shorter turnaround time and a higher sensitivity for pathogen detection and can provide evidence for the pathogenic diagnosis of children with agranulocytosis and fever.
探讨宏基因组下一代测序（mNGS）技术在儿童发热性粒细胞缺乏症病原体检测中的应用价值。
回顾性分析2020年1月至2021年12月收治的116例发热性粒细胞缺乏症患儿的mNGS病原体检测结果。其中，mNGS结果阴性的38例患儿作为阴性组，结果阳性的78例患儿分为细菌组（n = 22）、真菌组（n = 23）和病毒组（n = 31）。比较各组临床资料。
116例发热性粒细胞缺乏症患儿诊断时中位年龄为8岁，mNGS结果中位回报时间为2天，mNGS检测阳性率为67.2%（78/116）。与阴性组相比，细菌组降钙素原水平更高（P<0.05），真菌组C反应蛋白水平及（1,3）-β-D葡聚糖试验/半乳甘露聚糖试验阳性率更高（P<0.05），真菌组发热持续时间更长（P<0.05）。22份微生物培养阳性标本中，9份（41%）与mNGS结果一致。17份血培养阳性标本中，8份（47%）与mNGS结果一致。根据mNGS结果调整治疗方案的患儿有28例（36%），其中26例治愈出院。
mNGS技术检测病原体的回报时间短、灵敏度高，可为儿童发热性粒细胞缺乏症的病原学诊断提供依据。
