Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China.
Department of Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Front Cell Infect Microbiol. 2022 Oct 27;12:1026739. doi: 10.3389/fcimb.2022.1026739. eCollection 2022.
pneumonia (PJP) remains an important cause of morbidity and mortality in non-HIV immunocompromised patients especially in transplant recipients. But its diagnosis remains challenging due to the insuffificient performance of conventional methods for diagnosing infection. Therefore, the auxiliary diagnostic function of metagenomics next-generation sequencing (mNGS) in clinical practice is worth of exploring.
34 non-HIV immunocompromised patients who were diagnosed as PJP by clinical manifestations, imaging findings, immune status of the host, and Methenamine silver staining were tested by mNGS from October 2018 to December 2020 in Sichuan Provincial People's Hospital. The clinical performances of mNGS for infection diagnosis were also evaluated with genome reads abundance and comparing with other traditional diagnostic methods.
We diagnosed a total of 34 non-HIV PJP patients by the clinical composite diagnosis. Our data shows that, compared with the clinical microbiological test, the detection rate of mNGS for in non-HIV infected PJP patients is significantly higher than that of Methenamine silver staining and serum 1-3-β-D-glucan. mNGS can be used as an auxiliary diagnostic tool to help diagnosis. The number of reads mapped to the genome of and the duration of patients from onset to sampling collection were statistically significant between the two groups (Reads>100 and Reads ≤ 100) (8days . 23days, =0.020). In addition, univariate analysis showed that C-reactive protein (15.8mg/L .79.56mg/L, =0.016), lactate dehydrogenase (696U/l . 494U/l, =0.030) and procalcitonin (0.09ng/ml . 0.59ng/ml, =0.028) was also statistically significant between the two groups.
An effective detection rate was achieved in PJP patients using mNGS testing of bronchoalveolar lavage fluid (BALF) or blood. The study also confirmed that the abundance of reads of is related to the interval between the onset and sample collection. And the inflammation status during simultaneous mNGS detection might determine the abundance of pathogens. Hence, we conclude that the mNGS strategy could benefit disease diagnosis as well as treatment when complicated clinical infections appeared.
肺炎（PJP）仍然是非 HIV 免疫功能低下患者，尤其是移植受者发病率和死亡率的重要原因。但由于传统方法诊断感染的性能不足，其诊断仍然具有挑战性。因此，宏基因组下一代测序（mNGS）在临床实践中的辅助诊断功能值得探索。
2018 年 10 月至 2020 年 12 月，四川省人民医院对 34 例经临床表现、影像学表现、宿主免疫状态和对苯二胺银染色诊断为 PJP 的非 HIV 免疫功能低下患者进行 mNGS 检测。还评估了 mNGS 对感染诊断的临床性能，并用基因组读数丰度与其他传统诊断方法进行比较。
我们通过临床综合诊断共诊断了 34 例非 HIV 性 PJP 患者。我们的数据表明，与临床微生物学检测相比，mNGS 检测非 HIV 感染性 PJP 患者中感染的检出率明显高于对苯二胺银染色和血清 1-3-β-D-葡聚糖。mNGS 可作为辅助诊断工具帮助诊断。两组之间（读数>100 和读数≤100）映射到基因组的读数数量和患者从发病到采样采集的时间有统计学意义（8 天. 23 天，=0.020）。此外，单因素分析表明，C 反应蛋白（15.8mg/L.79.56mg/L，=0.016）、乳酸脱氢酶（696U/l. 494U/l，=0.030）和降钙素原（0.09ng/ml. 0.59ng/ml，=0.028）在两组之间也有统计学意义。
通过支气管肺泡灌洗液（BALF）或血液的 mNGS 检测，在 PJP 患者中实现了有效的检测率。该研究还证实，读取物的丰度与发病和样本采集之间的间隔有关。同时进行 mNGS 检测时的炎症状态可能决定病原体的丰度。因此，我们得出结论，当出现复杂的临床感染时，mNGS 策略可以有助于疾病诊断和治疗。
