Pneumocystis Jirovecii Pneumonia Diagnosis via Metagenomic Next-Generation Sequencing.

Xiaoxiao Lu,Wentao Ma,Mengying Yao,Jianhui Zhang,Hanbing Ning,Lihua Xing

doi:10.3389/fmed.2022.812005

Xiaoxiao Lu, Wentao Ma + Show 4 more

Open Access

https://doi.org/10.3389/fmed.2022.812005

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Abstract

The incidence of non-HIV-infected Pneumocystis Jirovecii Pneumonia (PJP) is increasing. The prognosis for non-HIV PJP is poor and diagnostic tests are of lower sensitivity in non-HIV patients. Metagenomic next-generation sequencing (mNGS) was compared with routine detection assays, including Gomori methenamine silver (GMS) stain and polymerase chain reaction (PCR) technique. Specimens of 4 bronchoalveolar lavages (BAL) and 1 lung tissue samples were obtained from 4 non-HIV patients from our hospitals. Although both GMS and mNGS were positive for P. jirovecii with PCR as positive control, the testing time of mNGS was obviously shorter than GMS. Compared with the traditional GMS method, mNGS has absolute advantages. However, the issue with PJP presentations having atypical symptoms and ambiguous imaging features persists. Hence, the disease can easily be ignored. Secondly, PJP progresses rapidly in non-HIV-infected patients and can cause severe respiratory failure with unfavorable prognosis. This study affirms that mNGS can be used to quickly and accurately diagnose PJP, but a combination of clinical judgement of symptoms, laboratory testing, and imaging examination is required to make a comprehensive judgment along with mNGS test results.

Highlights

Pneumocystis carinii pneumonia (PJP) is a potentially life-threatening opportunistic pathogenic fungal infection caused by P. jirovecii
Patients who were suspected to have Pneumocystis Jirovecii Pneumonia (PJP) by two or more expert professors were assessed by polymerase chain reaction (PCR), Gomori methenamine silver (GMS), and Metagenomic next-generation sequencing (mNGS) analysis
We discovered a total of four patients with PJP

Summary

Introduction

Pneumocystis carinii pneumonia (PJP) is a potentially life-threatening opportunistic pathogenic fungal infection caused by P. jirovecii. PJP was the most common opportunistic infection in people with HIV infection or Acquired Immune Deficiency Syndrome (AIDS). In recent years, the incidence of PJP in patients with HIV has decreased due to the use of highly active antiretroviral therapy (HAART) and preventive treatment against P. jirovecii. PJP was known to be a rare non-HIV illness that occur in immunocompromised individuals even before advent of HIV. It had reported mortality rates that ranged from 19.6 to 52% in non-HIV patients [1–3], which is significantly higher than in HIV-infected patients [3–5]. In contrast to HIV-infected patients, there is evidence for a more acute onset of symptoms, faster progression of disease, poorer outcome, higher mortality, and higher risk of coinfections [6–10]

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