ABSTRACT
Objective:
To explore the application of
metagenomics next generation sequencing(mNGS)in the immunosuppressed
children with severe
pneumonia and to understand the distribution of pathogens in order to provide reference for early prevention and
treatment.
Methods:
We performed a retrospective
analysis of the immunosuppressed
children with severe
pneumonia who had mNGS
reports admitted to PICU according with the enrollment condition from July 2019 to July 2020.The
records included general clinical data, traditional
detection method report and mNGS results.We evaluated the consistency of the mNGS with the clinical
microbiology reports and clinical
judgment.
Results:
Twenty-three
patients were enrolled, 15 were
male and 8 were
female,
aging from 28 days to 10 years old, with an average age of(3.67±3.20)years old.Seven cases were cured, 2 were improved, and 14 died.A total of 23 samples were obtained, including 21
blood specimens and 2 bronchoal-veolar
lavage fluid specimens.Among the 23 cases, 5 were single infected and 15 were mixed infected.
Fungi were detected in 15 cases(65.22%), including 12 cases of
Pneumocystis jirovecii, 2 cases of
Aspergillus fumigatus and 2 cases of
Candida albicans.
Virus were detected in 14 cases(60.87%), including
cytomegalovirus(CMV) in 10 cases(8 cases with
pneumocystis infection), Herpes
virus in 3 cases and fine ring
virus in 2 cases(1 case with herpes
virus infection).
Bacteria were detected in 10 cases, including 3 cases of
Acinetobacter, 1 case of
Klebsiella pneumoniae, 1 case of
Stenotrophomonas maltophilia, 1 case of Pinocytogenes, 4 cases of
Staphylococcus and 1 case of
Bacillus licheniformis.There were
Mycoplasma in 3 cases with
mixed infection.The positive rate and coincidence rate of mNGS were significantly higher than that of the traditional test group( P<0.05). A total of 19 cases were treated with
hormone or
immunosuppressive agents, and 17 cases were treated for 1 to 6 months when severe
pneumonia occurred.
Conclusion:
Most immunosuppressed
children with severe
pneumonia are
mixed infection.The common pathogens are
Pneumocystis jirovecii and CMV.The use of mNGS can significantly improve the pathogen
detection rate, effectively guiding the
treatment.