BALF metagenomic next-generation sequencing analysis in hematological malignancy patients with suspected pulmonary infection: clinical significance of negative results
PurposeMetagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) is gradually being used in hematological malignancy (HM) patients with suspected pulmonary infections. However, negative results are common and the clinical value and interpretation of such results in this pa...
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Frontiers Media S.A.
2023-06-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2023.1195629/full |
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| author | Zuqun Deng Yishu Tang Yixuan Tu Mei Liu Qian Cheng Jian Zhang Feiyang Liu Xin Li |
| author_facet | Zuqun Deng Yishu Tang Yixuan Tu Mei Liu Qian Cheng Jian Zhang Feiyang Liu Xin Li |
| author_sort | Zuqun Deng |
| collection | DOAJ |
| description | PurposeMetagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) is gradually being used in hematological malignancy (HM) patients with suspected pulmonary infections. However, negative results are common and the clinical value and interpretation of such results in this patient population require further analysis.MethodsRetrospective analysis of 112 HM patients with suspected pulmonary infection who underwent BALF mNGS and conventional microbiological tests. The final diagnosis, imaging findings, laboratory results and treatment regimen of 29 mNGS-negative patients were mainly analyzed.ResultsA total of 83 mNGS positive and 29 negative patients (15 true-negatives and 14 false-negatives) were included in the study. Compared to false-negative patients, true-negative patients showed more thickening of interlobular septa on imaging (p < 0.05); fewer true-negative patients had acute respiratory symptoms such as coughing or sputum production (p < 0.05) clinically; On the aspect of etiology, drug-related interstitial pneumonia (6/15, 40%) was the most common type of lung lesion in true-negative patients; on the aspect of pathogenesis, false-negative patients mainly missed atypical pathogens such as fungi and tuberculosis (8/14, 57.1%). Regarding treatment, delayed anti-infection treatment occurred after pathogen missing in mNGS false-negative patients, with the longest median time delay observed for anti-tuberculosis therapy (13 days), followed by antifungal therapy (7 days), and antibacterial therapy (1.5 days); the delay in anti-tuberculosis therapy was significantly longer than that in antibacterial therapy (p < 0.05).ConclusionFor HMs patients with imaging showing thickening of interlobular septa and no obvious acute respiratory symptoms, lung lesions are more likely caused by drug treatment or the underlying disease, so caution should be exercised when performing BALF mNGS. If BALF mNGS is negative but infection is still suspected, atypical pathogenic infections should be considered. |
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| language | English |
| last_indexed | 2024-03-13T02:46:56Z |
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| series | Frontiers in Medicine |
| spelling | doaj.art-f3f38bbe022841b0911f481a58a704f82023-06-28T14:47:43ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-06-011010.3389/fmed.2023.11956291195629BALF metagenomic next-generation sequencing analysis in hematological malignancy patients with suspected pulmonary infection: clinical significance of negative resultsZuqun Deng0Yishu Tang1Yixuan Tu2Mei Liu3Qian Cheng4Jian Zhang5Feiyang Liu6Xin Li7Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Emergency, The Third Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, ChinaPurposeMetagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) is gradually being used in hematological malignancy (HM) patients with suspected pulmonary infections. However, negative results are common and the clinical value and interpretation of such results in this patient population require further analysis.MethodsRetrospective analysis of 112 HM patients with suspected pulmonary infection who underwent BALF mNGS and conventional microbiological tests. The final diagnosis, imaging findings, laboratory results and treatment regimen of 29 mNGS-negative patients were mainly analyzed.ResultsA total of 83 mNGS positive and 29 negative patients (15 true-negatives and 14 false-negatives) were included in the study. Compared to false-negative patients, true-negative patients showed more thickening of interlobular septa on imaging (p < 0.05); fewer true-negative patients had acute respiratory symptoms such as coughing or sputum production (p < 0.05) clinically; On the aspect of etiology, drug-related interstitial pneumonia (6/15, 40%) was the most common type of lung lesion in true-negative patients; on the aspect of pathogenesis, false-negative patients mainly missed atypical pathogens such as fungi and tuberculosis (8/14, 57.1%). Regarding treatment, delayed anti-infection treatment occurred after pathogen missing in mNGS false-negative patients, with the longest median time delay observed for anti-tuberculosis therapy (13 days), followed by antifungal therapy (7 days), and antibacterial therapy (1.5 days); the delay in anti-tuberculosis therapy was significantly longer than that in antibacterial therapy (p < 0.05).ConclusionFor HMs patients with imaging showing thickening of interlobular septa and no obvious acute respiratory symptoms, lung lesions are more likely caused by drug treatment or the underlying disease, so caution should be exercised when performing BALF mNGS. If BALF mNGS is negative but infection is still suspected, atypical pathogenic infections should be considered.https://www.frontiersin.org/articles/10.3389/fmed.2023.1195629/fullmetagenomic next-generation sequencingpulmonary infectionbronchoalveolar lavage fluidpathogendiagnosis |
| spellingShingle | Zuqun Deng Yishu Tang Yixuan Tu Mei Liu Qian Cheng Jian Zhang Feiyang Liu Xin Li BALF metagenomic next-generation sequencing analysis in hematological malignancy patients with suspected pulmonary infection: clinical significance of negative results Frontiers in Medicine metagenomic next-generation sequencing pulmonary infection bronchoalveolar lavage fluid pathogen diagnosis |
| title | BALF metagenomic next-generation sequencing analysis in hematological malignancy patients with suspected pulmonary infection: clinical significance of negative results |
| title_full | BALF metagenomic next-generation sequencing analysis in hematological malignancy patients with suspected pulmonary infection: clinical significance of negative results |
| title_fullStr | BALF metagenomic next-generation sequencing analysis in hematological malignancy patients with suspected pulmonary infection: clinical significance of negative results |
| title_full_unstemmed | BALF metagenomic next-generation sequencing analysis in hematological malignancy patients with suspected pulmonary infection: clinical significance of negative results |
| title_short | BALF metagenomic next-generation sequencing analysis in hematological malignancy patients with suspected pulmonary infection: clinical significance of negative results |
| title_sort | balf metagenomic next generation sequencing analysis in hematological malignancy patients with suspected pulmonary infection clinical significance of negative results |
| topic | metagenomic next-generation sequencing pulmonary infection bronchoalveolar lavage fluid pathogen diagnosis |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2023.1195629/full |
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