<p>Metagenomic Next-Generation Sequencing in Diagnosis of a Case of <em>Pneumocystis jirovecii</em> Pneumonia in a Kidney Transplant Recipient and Literature Review</p>

Abstract

Background: Despite the increasing incidences of Pneumocystis jirovecii pneumonia (PCP) in renal transplant recipients, diagnosis of PCP remains challenging due to its nonspecific clinical presentation and the inadequate performance of conventional diagnostic methods. There is a need for novel diagnostic methods. Case Presentation: A 27-year-old woman developed acute pneumonia 4 months after renal transplantation. Blood tests revealed a low CD4 count, a normal 1,3-beta-D-glucan level and other changes typical of inflammatory responses. Chest imaging showed bilateral diffuse infiltrates. Microscopic examination of stained sputum and bronchoalveolar lavage fluid (BALF) smear specimens did not find Pneumocystis organisms. There was also no evidence for other pathogens known to cause pneumonia in various antibody and culture tests. Direct metagenomic next-generation sequencing (mNGS) analysis of a BALF specimen identified a large number of P. jirovecii reads, allowing to confirm the diagnosis of PCP. Following treatment with trimethoprim-sulfamethoxazole for two weeks, the patient was cured and discharged. Conclusion: This case report supports the value of mNGS in diagnosing PCP, highlights the inadequate sensitivity of conventional diagnostic methods for PCP, and calls for the need to add PCP prophylaxis to the current Diagnosis and Treatment Guideline of Invasive Fungal Infections in Solid Organ Transplant Recipients in China.

The risk factor analysis and treatment experience in pneumocystis jirovecii pneumonia after kidney transplantation

“…Final diagnosis of PJP was confirmed by the following two conditions. The diagnosis of PJP in our centre is mainly through lung tissue biopsy and bronchoalveolar lavage (BAL) followed by cytology smear technique and metagenomic next‐generation sequencing (mNGS) technology 17,18 . Due to technical limitations, our centre diagnosed PJP only by lung biopsy before 2016.…”

Application of Metagenomic Next-Generation Sequencing in The Diagnosis and Treatment Guidance of Pneumocystis Jirovecii Pneumonia in Renal Transplant Recipients

“…However, the e ciency of serum BDG test for diagnosing PJP is controversial. Some studies claimed that it lacked sensitivity and speci city [1,2], while in 3 metaanalyses, it was demonstrated to have a sensitivity of 91% to 96%, which is similar to the 92.9% (13/14) sensitivity of BDG in our present study at the admission [20][21][22]. We also found that the value of BDG assays at the admission was higher and was more likely positive in PJP patients than that in non-PJP patients by univariate analysis, suggesting the high sensitivity of BDG assays for PJP once again.…”

“…Pneumocystis jirovecii pneumonia (PJP) is a serious and even critical opportunistic infection, which usually occurs in renal transplant recipients (RTRs) who are prone to respiratory infections, accompanied by multiple infections [1].PJP cases have been reported frequently in solid organ transplant recipients, particularly in RTRs [2][3][4][5].…”

Co-Infection Pneumonia with Mycobacterium abscessus and Pneumocystis jiroveci in a Patient without HIV Infection Diagnosed by Metagenomic Next-Generation Sequencing

“…The pneumonia caused by M. abscessus and P. jirovecii present similar clinical features including fever and cough, which are nonspecific. 2 , 5 Traditional diagnostic techniques in the microbiology laboratory for P. jirovecii and M. abscessus have some limits: P. jirovecii still cannot be reliably grown in vitro and P. jirovecii organisms in respiratory specimens following immunofluorescence staining suffer from low sensitivity; 8 when the direct microscopic examination is positive for acid-fast bacilli, it is necessary to exclude the diagnosis of tuberculosis and other NTM organisms; M. abscessus cultures are not pigmented (neither scoto- nor photochromogen) and are similar to many other RGMs, such as M. chelonae; 9 and the PCR of P. jirovecii and M. abscessus is not available in clinical settings in most hospitals in China including our hospital.…”

“…Metagenomic next generation sequencing (mNGS) is a powerful tool for detecting pathogens that can be performed directly on clinical specimens. 10 , 11 It had been used for detection of P. jiroveci , 8 , 10 and M. abscessus . 12 In this report, we describe a previously healthy HIV-negative male coinfected with M. abscessus and P. jiroveci detected by mNGS.…”