Recurrent Pneumonia With Tuberculosis and Candida Co-infection Diagnosed by Metagenomic Next-Generation Sequencing: A Case Report and Literature Review

Abstract

An 82-year-old male patient was hospitalized in the Respiratory Department for “repeated cough and shortness of breath for 10 years, recurrence worsened for 1 month.” Later, he was transferred for further diagnosis and treatment, to the Infectious Disease Department for further hospitalization. Previously, the patient had repeatedly undergone tuberculosis-related examinations including bronchoscopy examinations. However, no evidence of Mycobacterium tuberculosis (MTB) infection was found. Early anti-infection treatments failed. Due to repeated symptoms, we performed bronchoscopy again and sent alveolar lavage fluid for the metagenomic next-generation sequencing (mNGS) test. Subsequently, MTB and Candida albicans were detected by mNGS. After antituberculosis and antifungal treatments, the symptoms were significantly relieved, and the chest CT showed resolution of the lung lesions. Therefore, we successfully diagnosed and treated a case of recurrent pneumonia with tuberculosis and Candida co-infection diagnosed by mNGS.

Application of metagenomic next-generation sequencing in cutaneous tuberculosis

“…The rest of the data were assembled using PMSEQ bioinformatics analysis software and classified via simultaneous alignment to the pathogen metagenomics database (PMDB) containing 17,500 pathogens. To date, the PMDB contains 10,989 bacterial genomes or scaffolds (196 Mycobacterium and 159 Mycoplasma, Chlamydia, and Rickettsia), 1,179 fungi related to human diseases, 5,050 whole-genome sequences of viral taxa, and 282 parasites associated with human infection (Chen et al, 2021;Yu et al, 2021;Ma et al, 2022).…”

“…For example, the mNGS result was positive when the number of bacterial or viral reads was 10-fold greater than that of any other microbes and when the number of fungi (species level) was 5-fold greater than that of other fungi. A positive result for mNGS was given as long as the number of MTBC reads at the genus level was only 1 (Ma et al, 2022). The stringent mapped reads number (SMRN) and genomic coverage (GC) were also used as references.…”

“…This increases the difficulty of clinical diagnosis and treatment. Therefore, rapid clarification of the etiology is necessary (Ma et al, 2022). Clinically, treatment is administered according to the doctor's experience in most cases, leading to a higher possibility of the development of drug-resistant bacteria and the possible occurrence of secondary infections (Rimola et al, 2000;Grek and Arasi, 2016;Nanchal and Ahmad, 2016).…”