BackgroundDifferentiating Pneumocystis jirovecii infection from colonisation is crucial for appropriate therapy administration. In this study, we evaluated the performance of bronchoalveolar lavage fluid (BAL) metagenomic next-generation sequencing (mNGS) and serum 1,3-β-D-glucan (BDG) tests in differentiating colonisation and infection with P. jirovecii.MethodsFrom January 2018 to March 2021, 47 patients were enrolled in this study at the Hunan Provincial People’s Hospital. The final diagnosis was used as a reference, and cases were classified into the P. jirovecii pneumonia (PJP) group or the P. jirovecii colonisation (PJC) group. Clinical data were recorded. The performances of mNGS and BDG were compared.ResultThe fungal load significantly differed between patients with PJP and PJC, with median reads of 3,215.79 ± 1,797 vs. 5.61 ± 0.88 in the PJP and PJC groups, respectively (P < 0.0001). BDG also significantly differed between the two groups, with a median titre of 233.60 ± 39.65 pg/ml in the PJP group and 68.48 ± 19.21 pg/ml in the PJC group (P = 0.0006). The area under the curve was 0.973 (95%CI: 0.868–1.007) for mNGS of the BAL and 0.879 (95%CI: 0.769–0.989) for the serum BDG. The optimal threshold value for discriminating P. jirovecii infection from colonisation appeared to be 14 reads (sensitivity, 83.3%; specificity, 95.7%; positive likelihood ratio, 19.2) and BDG = 88.6 pg/ml (sensitivity, 79.2%; specificity, 92.9%; positive likelihood ratio, 18.2). No correlation between mNGS reads and the BDG titre was found in mNGS-positive patients (r2 = 0.0076, P = 0.583). The levels of lactate dehydrogenase and C-reactive protein were significantly higher in the PJP group than in the PJC group.ConclusionBAL mNGS and serum BDG are useful adjunct tests that can assist with differentiating between colonisation and infection of P. jirovecii.

Background: Metagenomic next-generation sequence (mNGS) is an emerging powerful pan-pathogen test for the diagnosis of infectious diseases. However, the application of mNGS in acquired immunodeficiency syndrome with opportunistic infections is limited to clinical cases reports and central nervous system infection.In this study, we evaluated the diagnostic value of mNGS in acquired immunodeficiency syndrome(AIDS) with opportunistic infections(OIs).Methods: From January 2018 to February 2021,86 cases were enrolled in this retrospective analysis. All patients underwent mNGS. Clinical data were recorded.Result: In the present study, mNGS identified 76 of 86 infection cases (88.37%).Human betaherpesvirus 5 (CMV) (40.70%), Human gammaherpesvirus 4 (EBV) (40.70%),pneumocystis (31.40%) were the most common pathogens detected. The sensitivity of mNGS (88.37%,76/86) was higher than that of culture (22.10%, 19/86),smear(7%,6/86) and PCR(46.51%,40/86).In the detection of viruses such as (CMV and EBV), the consistency between PCR and mNGS of CMV and EBV was 100%,73.33% respectively. All PCP cases were detected by mNGS. The consistency in detection of talaromyces between culture and mNGS was 75%.mNGS is superior to the common methods such as culture and smear in the detection of mycobacterium tuberculosis and non-mycobacterium tuberculosis. The mNGS findings led to changes in treatment strategies in 47/86 (54.65%) cases. Compared with the patients’treatment before mNGS, patients had lower rate of broad-spectrum antibiotic drugs use during clinical treatment after mNGS 78/86(90.70%) vs 34/86(39.53%)（P<0.0001). Conclusion: mNGS showed a satisfying diagnostic performance in acquired immunodeficiency syndrome with opportunistic infections. mNGS may lead to a more precise antimicrobial treatment and reduced the use of antibiotic medicine.

Background For acquired immunodeficiency syndrome (AIDS) patients with suspected opportunistic infections, the rapid and accurate identification of pathogens remains a challenge. Metagenomic next-generation sequencing (mNGS) has emerged as a pan-pathogen assay for infectious diseases diagnosis, but its guiding significance for diagnosis and antimicrobials treatment in AIDS patients with suspected opportunistic infections is still not well established. In this study, we compared the microbiological diagnostic value of mNGS with that of conventional microbiological tests (CMTs) in AIDS patients with suspected opportunistic infections. Methods From January 2018 to February 2021, a retrospective study was performed at four tertiary teaching hospitals in China and data of 86 AIDS patients with suspected opportunistic infections were collected. The pathogen detection performance of mNGS and CMTs were compared. Results Positive agreement between mNGS and clinical diagnosis was significantly higher than that of CMTs (65/86 (75.6%) vs 37/86 (43.0%)). In addition, mNGS identified more bacterial (25 vs 2), fungal (5 vs 3), viral (9 vs 2) organisms compared with CMTs. Mixed infection were detected in 34 patients by mNGS combined with CMTs. Viruses (94.1%, 32/34) and fungi (94.1%, 32/34) were commonly seen in the mixed infection cases. mNGS helped identify the pathogen or guide appropriate treatment in 49/86 (57%) patients. Meanwhile, CMTs also contributed in the decision of appropriate treatment in 28 patients. The successful de-escalation or discontinuation of treatment was supported in 37 patients with the help of mNGS. We observed a significant reduction in the number of patients being prescribed foscarnet (52.3% vs 23.26%, p < 0.001), moxifloxacin (34.9% vs 10.5%, p = 0.005), and levofloxacin (32.6% vs 14%, p = 0.001) before and after mNGS. Conclusion For AIDS patients with suspected opportunistic infections, mNGS can provide early, noninvasive, and rapid microbiological diagnosis. mNGS may lead to a more precise antimicrobial treatment and reduced the unreasonable use of antimicrobials.

Background: Coronavirus disease 2019 (COVID-19) has been highly epidemic in the whole world now. Asymptomatic transmission of severe acute respiratory coronavirus-2 (SARS-CoV-2)might pose challenges for disease control. Little information on its characteristics of asymptomatic COVID-19 carriers is available. This study aimed to clarify the clinical feature and follow-up data of asymptomatic COVID-19 carriers, We hope the information would help the management of asymptomatic