Value of metagenomic next-generation sequencing to the diagnosis of immunocompromised host pneumonia
Objective To observe the clinical characteristics of immunocompromised host pneumonia(ICHP)and to explore the value of metagenomic next-generation sequencing(mNGS)in bronchoalveolar lavage fluid(BALF)to the diagnosis of ICHP.Methods Fifty-five patients with ICHP were diagnosed and treated in Henan Provincial People's Hospital from June 2021 to June 2023.All patients received bronchoscopy,BALF mNGS and conventional microbiological test(CMT).The detection rates of pathogenic microorganisms by mNGS and CMT were recorded and compared.Among these 55 patients,37 had multiple lesions in both lungs and were divided into diffuse group(n=18)and non-diffuse group(n=19)according to the presence or absence of diffuse ground-glass opacities in both lungs.The detected pathogenic microorganisms were compared between two groups.Results Among these 55 patients,37 were detected fungi,including 20 cases of molds and 22 cases of Pneumocystis Jiroveci;30 patients were detected bacteria,including 7 cases of Klebsiella pneumoniae,7 cases of Pseudomonas aeruginosa,4 cases of Staphylococcus,2 cases of Streptococcus pneumoniae,6 cases of Mycobacterium tuberculosis,2 cases of Tropheryma whipplei and 2 cases of Nocardia;38 cases were detected viruses,including 18 cases of cytomegalovirus,21 cases of Epstein-Barr virus,7 cases of novel coronavirus,4 cases of human herpes virus type 1,and 2 cases of influenza virus;43 patients were detected mixed infection.The pathogenic microorganisms were detected in 49 patients by mNGS,in 19 by CMT,and in 13 by the combination of them two.The detection rate of pathogenic microorganisms was higher by mNGS(89.1％)than that by CMT(34.5％)(x2=9.720,P=0.002).The detection rate of Pneumocystis jiroveci was higher in diffuse group(61.1％)than that in non-diffuse group(26.3％)(x2=4.560,P=0.033).There were no significant differences in the detection rates of molds,bacteria and viruses between two groups(P＞0.05).Conclusions BALF mNGS is superior to CMT in detecting pathogens in ICHP,and the combination of them two has better performance.Diffuse ground-glass opacity in both lungs in ICHP patients suggests Pneumocystis jiroveci infection.
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