P0262DIAGNOSIS OF PNEUMOCYSTIS PNEUMONIA BY METAGENOMIC NEXT-GENERATION SEQUENCING IN PERIPHERAL BLOOD OF PATIENTS WITH KIDNEY DISEASE

Abstract

Abstract Background and Aims Pneumocystis jirovecii is an opportunistic infectious pathogen that can cause pneumocystis pneumonia in HIV patients. The kidney transplant recipients and patients with kidney diseases receive immunosuppressive therapy, PCP is not uncommon in such patients, but early etiological diagnosis is difficult. Metagenomic next-generation sequencing (mNGS) has higher sensitivity for pathogen identification in a variety of infections. In this study, mNGS was used to detect peripheral blood samples of patients with kidney disease complicated with PCP, and to evaluate the diagnostic value of mNGS in peripheral blood for the etiology of PCP. Method From August 2018 to December 2019, We collected 37 cases with kidney disease complicated with pulmonary infection and clinically diagnosed with PCP after receiving immunosuppressive therapy. mNGS was used to analyze the pathogen types and sequences in peripheral blood samples to evaluate the detection efficiency to PCP. To compare the efficacy of mNGS and traditional clinical diagnosis (fungal G combined with lactate dehydrogenase detection) of PCP. In addition, patients with Bacterial/fungal pneumonia or viral pneumonia were mNGS positive controls. Results 37 peripheral blood samples were collected from 37 patients, results for all samples were obtained within 72 hours. Pneumocystis jirovecii was detected by mNGS in 35 of the 37 samples, with a sensitivity of 94.59%, specificity of 100%. 31 patients had mixed infection. Cytomegalovirus (CMV) was detected in 19 of the 37 cases (51.4%), epstein-barr virus (EBV) was detected in 6 cases, herpes simplex virus (HSV) was detected in 5 cases, and Torquetenovirus was detected in 8 cases. There were 8 cases of bacterial infection, including 2 cases of staphylococcus, 2 cases of acinetobacter, 1 case of klebsiella pneumoniae, 1 case of escherichia coli, and 4 cases of other uncommon bacteria. There were 33 patients with positive fungal G test and elevated lactate dehydrogenase (BG/LDH), and 4 patients with multiple negative fungal G test .The sensitivity of BG/LDH was 89.19%, the specificity was 56.0%. Conclusion mNGS has obvious advantages over the traditional method of diagnosing PCP. It has the characteristics of accuracy, simplicity and noninvasiveness, and is of great value for the early diagnosis of PCP.