Application of metagenomic next-generation sequencing technology in mycobacterium tuberculosis infection after allogeneic hematopoietic stem cell transplantation
Objective:To explore the application of metagenomic next-generation sequencing(mNGS)technol-ogy in mycobacterium tuberculosis(MTB)infection after allogeneic hematopoietic stem cell transplantation.Methods:The clinical data of 11 patients with MTB infection after allogeneic hematopoietic stem cell transplanta-tion diagnosed by mNGS from January 2018 to May 2020 were retrospectively analyzed.Results:Of the 11 pa-tients,there were 6 males and 5 females.The median age was 45(28-56)years old.The main type of tuberculosis was pulmonary tuberculosis(9 cases,81.8％).Other types included 1 case of tuberculous meningitis and 1 case of tuberculous bacteremia.The median duration of MTB presentation after transplantation was 4.1 months(range 1.1-12.1 months).The clinical manifestations were mainly fever and respiratory symptoms,including 7 cases of fever,8 cases of respiratory symptoms,and 1 case of tuberculous meningitis with fever,headache and epilepsy.Laboratory examination:Three out of 11 patients(27.3％)showed positive acid-fast staining on smears(2 cases of bronchoalveolar lavage fluid and 1 case of cerebrospinal fluid);9 cases(81.8％)were T-SPOT positive in periph-eral blood;5 cases(45.5％)were Xpert positive(4 cases of bronchoalveolar lavage fluid and 1 case of cerebrospinal fluid);1 case(9.1％)had positive peripheral blood MTB-PCR.The MTB sequence number of all the patients were detected by mNGS(between 1-154).Image findings:The chest CT showed patched shadow in 7 cases,mass shadow near mediastinum in 1 case,multiple miliary nodular shadow in 1 case.Brain MRI revealed multiple nodu-lar lesions in one patient with tuberculous meningitis.After active treatment,9 patients were cured of MTB infec-tion,and 1 patient died of severe mixed infection in the lungs without control,the other one died of MTB infec-tion,with an overall cure rate of 81.8％(9/11).Conclusion:mNGS technology can significantly improve the de-tection rate of MTB after allogeneic hematopoietic stem cell transplantation,providing important pathogenic basis for early and precise clinical treatment.
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