Department of Respiratory and Critical Care Medicine, the Second Clinical Hospital of Chongqing Medical University, Chongqing, China.
Department of Scientific Affairs, Vision Medicals Center for Infection Diseases, Guangzhou, China.
Front Cell Infect Microbiol. 2023 Jan 24;12:1083497. doi: 10.3389/fcimb.2022.1083497. eCollection 2022.
The incidence of non-tuberculous mycobacterial pulmonary disease (NTM-PD) has increased steadily globally, but the current culture-based diagnosis of NTM-PD is difficult and time-consuming, leading to a high possibility of misdiagnosis. Therefore, new methods should be introduced to improve the processes for clinical diagnosis of this disease.
Our retrospective observational study enrolled 12 NTM-PD patients who were identified by way of metagenomic next-generation sequencing (mNGS), as well as the characteristic radiological presentation of slowly progressed, usually concomitant bronchiectasis, small cavitary opacity, and multiple nodules that respond poorly to empirical antibiotic therapy. These patients received the recommended drug regimen based on the identified non-tuberculous mycobacteria (NTM) species. Clinical data, including symptoms, laboratory tests, dynamic computed tomography imaging, treatment, and outcome, were recorded and analyzed.
The results of mNGS were all positive, with the standard specifically mapped read numbers (SDSMRN) of NTM ranging from 1 to 766; this was confirmed in six patients via quantitative polymerase chain reaction (qPCR) analysis. The duration fromsample collection tomNGS results was 1-4 days. Among our 12 patients (except for one lost to follow-up) the CT imaging for 11 patients showed significant absorption of lesions.
Our results draw attention to NTM infection as a possible cause of community-acquired pneumonia, especially in patients with suggestive radiological presentation and poor responses to empirical antibiotic therapy. Our study also indicated that mNGS represented a potentially effective tool for the rapid identification of NTM in the respiratory sample. Improved clinician awareness combined with the utilization of mNGS could guide earlier diagnosis and targeted treatment, and finally improved the prognoses of patients with NTM-PD.
非结核分枝杆菌肺病（NTM-PD）的发病率在全球范围内稳步上升，但目前基于培养的 NTM-PD 诊断困难且耗时，导致误诊的可能性很高。因此，应该引入新的方法来改进这种疾病的临床诊断流程。
我们的回顾性观察性研究纳入了 12 例通过宏基因组下一代测序（mNGS）确定的 NTM-PD 患者，以及具有特征性的放射学表现，即缓慢进展、通常伴有支气管扩张、小空洞性不透明和多个结节，对经验性抗生素治疗反应不佳。这些患者根据鉴定出的非结核分枝杆菌（NTM）物种接受了推荐的药物治疗方案。记录和分析了包括症状、实验室检查、动态计算机断层成像、治疗和结果在内的临床数据。
mNGS 的结果均为阳性，NTM 的标准特异性映射读数（SDSMRN）范围为 1 至 766；其中 6 例通过定量聚合酶链反应（qPCR）分析得到了证实。从采集样本到 mNGS 结果的时间为 1-4 天。在我们的 12 例患者中（除了 1 例失访），11 例患者的 CT 成像显示病变明显吸收。
我们的结果提醒人们注意 NTM 感染可能是社区获得性肺炎的一个原因，特别是在具有提示性放射学表现和对经验性抗生素治疗反应不佳的患者中。我们的研究还表明，mNGS 代表了一种快速鉴定呼吸道样本中 NTM 的潜在有效工具。提高临床医生的认识并结合 mNGS 的应用，可能会指导更早的诊断和针对性治疗，最终改善 NTM-PD 患者的预后。
