Clinical application of metagenomic next-generation sequencing in acquired immunodeficiency syndrome patients with pulmonary infections
10.3760/cma.j.cn311365-20221220-00505
- VernacularTitle:宏基因组学二代测序在艾滋病合并肺部感染患者中的临床应用
- Author:
Pingzheng MO
1
;
Zhongwei ZHANG
;
Xiaoping CHEN
;
Zhiyong MA
;
Shihui SONG
;
Liangjun CHEN
;
Qinglian GUO
;
Yongxi ZHANG
;
Yong XIONG
;
Liping DENG
Author Information
1. 武汉大学中南医院感染科，武汉 430071
- Keywords:
Acquired immunodeficiency syndrome;
HIV;
Metagenomic next-generation sequencing;
Etiological examination;
Pulmonary infections;
Disease spectrum
- From:
Chinese Journal of Infectious Diseases
2023;41(8):507-513
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the pathogen spectrum of acquired immunodeficiency syndrome (AIDS) patients with pulmonary opportunistic infections in the local area, and to evaluate the clinical application of metagenomic next-generation sequencing (mNGS) in these patients.Methods:From January to December 2021, AIDS patients with pulmonary infections admitted to Zhongnan Hospital of Wuhan University were enrolled. Their bronchoalveolar lavage fluid (BALF) was subjected to mNGS and coventional pathogen detection.Routine pathogen detection methods included smear, culture, polymerase chain reaction (PCR), and immunochromatographic colloidal gold. Fisher′s exact probability method was used for statistical analysis.Results:A total of 69 patients were included, and all of them were tested positive for mNGS. Among them, 53 cases (76.8%) were positive for fungi and viruses, 40 cases (58.0%) were positive for bacteria (excluding Mycobacterium tuberculosis (MTB) and nontuberculous mycobacteria (NTM)), six cases were positive for MTB, 11 cases were positive for NTM, and seven cases were positive for other pathogens. Mixed infections with two or more pathogens were found in 89.9%(62/69) of the patients. Among the conventional pathogen detections of BALF, 79.7%(55/69) of the patients were positive for pathogens, including 42 cases positive for Pneumocystis jirovecii PCR, 16 cases positive for BALF culture, nine cases positive for MTB PCR, and five cases positive for Cryptococcus antigen. The total detection rate of mNGS was 100.0%(69/69), which was higher than that of the conventional pathogen detection rate of 79.7%(55/69), and the difference was statistically significant (Fisher′s exact probability method, P<0.001). The specificity of mNGS detection was 88.4%. Combining clinical and two detection methods, the top five pathogens were Pneumocystis jirovecii (62.3%(43/69)), Candida (29.0%(20/69)), MTB (20.3%(14/69)), NTM and Talaromyces marneffei (15.9%(11/69), each). Fifty-three patients (76.8%) had co-infection with virus. Conclusions:The main cause of pulmonary infection in AIDS patients in this area is mixed infection, and Pneumocystis jirovecii is the most common pathogen. mNGS could significantly improve the pathogen detection rate in AIDS patients with pulmonary infections.
