Diagnostic Value of mNGS in non-HIV Infected Patients with Chronic Kidney Disease Complicated with Pneumocystis Jirovecii Pneumonia
Objective To explore the diagnostic value of metagenomic next-generation sequencing(mNGS)in chronic kidney diseases(CKD)with pneumocystis jirovecii pneumonia(PJP).Methods A total of 10 non-human immunodeficiency virus(HIV)infected patients with CKD suspected to be complicated with PJP admitted to the Department of Nephrology of Tianjin Hospital of Tianjin University from September 10,2019 to August 21,2022 were included in this study.The clinical characteristics,diagnosis and treatment process of the patients were retrospectively analyzed to evaluate the diagnostic value of mNGS in patients with CKD complicated with PJP.Results A total of 10 cases of CKD with suspected PJP were included in this report,7 of which were sputum specimens and the remaining 3 were alveolar lavage fluid specimens.By mNGS detection,pneumocystis jirovecii was detected in all the 10 samples,and 9 of them were finally diagnosed as PJP.Among the 9 cases,all patients had fever,cough and phlegm,chest tightness and other pneumonia related manifestations.Laboratory findings included increased white blood cell count(70％),increased neutrophil ratio(100％),increased C-reactive protein(100％),decreased lymphocyte count(100％),negative HIV test,decreased albumin count(100％),increased creatinine level(100％),G test positive(70％),oxygenation index ≤300(70％)and elevated lactate dehydrogenase(100％),lung CT showed signs of lung infection,the above results suggested secondary immune deficiency with infection,but speculated that the pathogen results were not specific.Of the 9 patients,6 patients got better after treatment,and the remaining 3 patients died after treatment.Conclusion mNGS can be used in the early etiological diagnosis of secondary immunodeficiency diseases complicated with PJP,which provides strong etiological evidence for the timely and effective clinical treatment of pneumocystis jirovecii,and also highlights the great potential of this gene detection technology in the rapid diagnosis of pathogens.
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