Metagenomic next-generation sequencing-based diagnosis of Pneumocystis jirovecii pneumonia in patients without human immunodeficiency virus infection: A dual-center retrospective propensity matched study
Background: Pneumocystis jirovecii pneumonia (PJP), caused by Pneumocystis jirovecii (PJ), is an opportunistic infection prevalent in clinical settings. However, large-scale studies on the efficacy of metagenomic next-generation sequencing (mNGS)-based diagnosis of PJP in patients without human immu...
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Elsevier
2025-09-01
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| Series: | Journal of Infection and Public Health |
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| author | Jin-zhu Wang Jiang-bo Wang Ding Yuan Chang-hua Sun Lin-lin Hou Yan Zhang Xiang-hong Yang Hong-xiang Xie Yan-xia Gao |
| author_facet | Jin-zhu Wang Jiang-bo Wang Ding Yuan Chang-hua Sun Lin-lin Hou Yan Zhang Xiang-hong Yang Hong-xiang Xie Yan-xia Gao |
| author_sort | Jin-zhu Wang |
| collection | DOAJ |
| description | Background: Pneumocystis jirovecii pneumonia (PJP), caused by Pneumocystis jirovecii (PJ), is an opportunistic infection prevalent in clinical settings. However, large-scale studies on the efficacy of metagenomic next-generation sequencing (mNGS)-based diagnosis of PJP in patients without human immunodeficiency virus infection (HIV) are lacking. Methods: The study included 168 patients diagnosed with either PJP (84) or other pneumonia types (non-PJP patients; 84) who underwent mNGS-mediated bronchoalveolar lavage fluid (BALF) analysis, Gomori methenamine silver (GMS) staining and peripheral blood 1,3-beta-D-glucan (BDG) testing. Additionally, patients with PJP were categorized into survival (n = 55) and non-survival (n = 29) groups based on a 28-day in-hospital outcome to compare clinical characteristics, inflammatory markers, PJ sequence counts in BALF, and serum BDG levels. Results: Serum BDG levels, the proportion of patients with serum BDG of > 60 pg/mL and > 200 pg/mL were notably higher in the PJP group compared with that in the non-PJP group (all P< 0.05). The sensitivity and specificity of mNGS in diagnosing PJP were higher than those of serum BDG testing (sensitivity: 100 % vs. 63.0 %; specificity: 96.4 % vs. 90.4 %; both P< 0.05). The most common coinfection was viral (30.9 %), followed by bacterial–viral coinfections (13.0 %). Treatment regimens were altered for 83.3 % of patients based on the mNGS results. The patients in the non-survival group showed markedly higher serum BDG levels (142.5 [32.7, 277.7] vs. 123.0 [34.0, 164.0]) and a higher proportion of PJ sequence counts of > 1 × 105 (13.7 % vs. 0, P= 0.005) relative to those in the survival group. Conclusion: The mNGS showed superior performance over serum BDG testing and GMS staining in diagnosing PJP in non-HIV patients and identified a broader range of coinfections. |
| format | Article |
| id | doaj-art-ab78eba2dfc944a1a0ea05caeff61ada |
| institution | Kabale University |
| issn | 1876-0341 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
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| series | Journal of Infection and Public Health |
| spelling | doaj-art-ab78eba2dfc944a1a0ea05caeff61ada2025-08-20T03:42:34ZengElsevierJournal of Infection and Public Health1876-03412025-09-0118910283110.1016/j.jiph.2025.102831Metagenomic next-generation sequencing-based diagnosis of Pneumocystis jirovecii pneumonia in patients without human immunodeficiency virus infection: A dual-center retrospective propensity matched studyJin-zhu Wang0Jiang-bo Wang1Ding Yuan2Chang-hua Sun3Lin-lin Hou4Yan Zhang5Xiang-hong Yang6Hong-xiang Xie7Yan-xia Gao8Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, China; Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, ChinaEmergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, ChinaEmergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, ChinaEmergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, ChinaEmergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, ChinaEmergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, ChinaEmergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, ChinaDepartment of Clinical Laboratory Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong 250014, China; Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, China; Corresponding author at: Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, China.Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, China; Corresponding author.Background: Pneumocystis jirovecii pneumonia (PJP), caused by Pneumocystis jirovecii (PJ), is an opportunistic infection prevalent in clinical settings. However, large-scale studies on the efficacy of metagenomic next-generation sequencing (mNGS)-based diagnosis of PJP in patients without human immunodeficiency virus infection (HIV) are lacking. Methods: The study included 168 patients diagnosed with either PJP (84) or other pneumonia types (non-PJP patients; 84) who underwent mNGS-mediated bronchoalveolar lavage fluid (BALF) analysis, Gomori methenamine silver (GMS) staining and peripheral blood 1,3-beta-D-glucan (BDG) testing. Additionally, patients with PJP were categorized into survival (n = 55) and non-survival (n = 29) groups based on a 28-day in-hospital outcome to compare clinical characteristics, inflammatory markers, PJ sequence counts in BALF, and serum BDG levels. Results: Serum BDG levels, the proportion of patients with serum BDG of > 60 pg/mL and > 200 pg/mL were notably higher in the PJP group compared with that in the non-PJP group (all P< 0.05). The sensitivity and specificity of mNGS in diagnosing PJP were higher than those of serum BDG testing (sensitivity: 100 % vs. 63.0 %; specificity: 96.4 % vs. 90.4 %; both P< 0.05). The most common coinfection was viral (30.9 %), followed by bacterial–viral coinfections (13.0 %). Treatment regimens were altered for 83.3 % of patients based on the mNGS results. The patients in the non-survival group showed markedly higher serum BDG levels (142.5 [32.7, 277.7] vs. 123.0 [34.0, 164.0]) and a higher proportion of PJ sequence counts of > 1 × 105 (13.7 % vs. 0, P= 0.005) relative to those in the survival group. Conclusion: The mNGS showed superior performance over serum BDG testing and GMS staining in diagnosing PJP in non-HIV patients and identified a broader range of coinfections.http://www.sciencedirect.com/science/article/pii/S1876034125001807Pneumocystis jirovecii pneumoniaImmunodeficiencyNon-HIV patientsMetagenomic next-generation sequencingBronchoalveolar lavage fluidPathogen |
| spellingShingle | Jin-zhu Wang Jiang-bo Wang Ding Yuan Chang-hua Sun Lin-lin Hou Yan Zhang Xiang-hong Yang Hong-xiang Xie Yan-xia Gao Metagenomic next-generation sequencing-based diagnosis of Pneumocystis jirovecii pneumonia in patients without human immunodeficiency virus infection: A dual-center retrospective propensity matched study Journal of Infection and Public Health Pneumocystis jirovecii pneumonia Immunodeficiency Non-HIV patients Metagenomic next-generation sequencing Bronchoalveolar lavage fluid Pathogen |
| title | Metagenomic next-generation sequencing-based diagnosis of Pneumocystis jirovecii pneumonia in patients without human immunodeficiency virus infection: A dual-center retrospective propensity matched study |
| title_full | Metagenomic next-generation sequencing-based diagnosis of Pneumocystis jirovecii pneumonia in patients without human immunodeficiency virus infection: A dual-center retrospective propensity matched study |
| title_fullStr | Metagenomic next-generation sequencing-based diagnosis of Pneumocystis jirovecii pneumonia in patients without human immunodeficiency virus infection: A dual-center retrospective propensity matched study |
| title_full_unstemmed | Metagenomic next-generation sequencing-based diagnosis of Pneumocystis jirovecii pneumonia in patients without human immunodeficiency virus infection: A dual-center retrospective propensity matched study |
| title_short | Metagenomic next-generation sequencing-based diagnosis of Pneumocystis jirovecii pneumonia in patients without human immunodeficiency virus infection: A dual-center retrospective propensity matched study |
| title_sort | metagenomic next generation sequencing based diagnosis of pneumocystis jirovecii pneumonia in patients without human immunodeficiency virus infection a dual center retrospective propensity matched study |
| topic | Pneumocystis jirovecii pneumonia Immunodeficiency Non-HIV patients Metagenomic next-generation sequencing Bronchoalveolar lavage fluid Pathogen |
| url | http://www.sciencedirect.com/science/article/pii/S1876034125001807 |
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