Clinical Evaluation of Metagenomic Next-Generation Sequencing for the detection of pathogens in BALF in severe community acquired pneumonia

Abstract

Background Rapid and accurate identification of pathogens is very important for the treatment of Severe community-acquired pneumonia (SCAP) in children. Metagenomic Next-generation sequencing (mNGS) has been applied in the detection of pathogenic bacteria in recent years, while the overall evaluation the application of SCAP in children is lacking. Methods In our study, 84 cases of SCAP were enrolled. Bronchoalveolar lavage fluid (BALF) samples were analysed using mNGS; and sputum, blood, and BALF samples were analysed using conventional technology (CT). Results Among the 84 children, 41 were boys, and 43 were girls, with an average age ranging from 2 months to 14 years. The pathogen detection rate of mNGS was higher than that of CT (83.3% [70/84] vs. 63.1% [53/84], P = 0.003). The mNGS was much greater than that of the CT in detecting Streptococcus pneumoniae (89.2% [25/29] vs. 44.8% [13/29], P = 0.001) and Haemophilus influenzae (91.7% [11/12] vs. 33.3% [4/12], P < 0.005). The mNGS also showed superior fungal detection performance compared with that of the CT (81.8% [9/11] vs. 18.2% [2/11], P = 0.004). The mNGS test can detect viruses, such as bocavirus, rhinovirus, and human metapneumovirus, which are not frequently recognised using CT. However, the mNGS detection rate was lower than that of the CT (52.4% [11/21] vs. 95.2% [20/21], P = 0.004) for Mycoplasma pneumoniae (MP). The detection rate of mNGS for mixed infection was greater than that of the CT, although statistical significance was not observed (26.3% [20/39] vs. 21.1% [16/39], P > 0.005). Treatment for 26 (31.0%) children was changed based on mNGS results, and their symptoms were reduced; nine patients had their antibiotic modified, five had antibiotics added, nine had their antifungal medication, and seven had their antiviral medication. Conclusion mNGS has unique advantages in the detection of SCAP pathogens in children, especially S. pneumoniae, H. influenzae, and fungi. However, the detection rate of MP using mNGS was lower than that of the CT. Additionally, mNGS can detect pathogens that are not generally covered by CT, which is extremely important for the modification of the treatment strategy.

Mayaro Virus as the cause of Acute Febrile Illness in the Colombian Amazon Basin

“…Atypical viral pathogens such as Pegivirus C and bacteria such as Klebsiella pneumoniae and non-tuberculous mycobacteria have been reported in febrile and patients with respiratory illness after metagenomic sequencing analysis ( del Valle-Mendoza et al, 2017 ; Oguzie et al, 2023 ; Shen et al, 2023 ; Wei et al, 2023 ; Yang et al, 2024 ). However, further research is needed to assess its implications in disease pathogenesis, specifically in disease cases of AFI of unknown origin.…”

Clinical Evaluation of Metagenomic Next-Generation Sequencing and Identification of Risk Factors in Patients with Severe Community-Acquired Pneumonia

“…[17][18][19] Up to date, many studies have explored the microbiological diagnostic performance of mNGS in LRTIs using bronchoalveolar lavage fluid (BALF) or sputum samples, which reveal a superior pathogen-positive detection rate compared with conventional tests, especially in atypical pathogens and mixed infections. [20][21][22] Considering a wide range of potential pathogens and the complexity of host background in ICU patients, although several scholars have been attracted to explore the clinical application of mNGS in these populations; 23,24 however, the clinical application evaluation of mNGS in SCAP with a larger cohort is still necessary across different geographical areas.…”