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Comprehensive Pathogen Spectrum Analysis Using mNGS in AIDS Patients With Pulmonary Infections: Diagnostic Value and
Wu Liang1,2, Liu Tingting3,4, Liu Ying1,2
1National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
Open Forum Infectious Diseases
|August 8, 2026
Summary
Metagenomic next-generation sequencing (mNGS) shows higher sensitivity for diagnosing pulmonary infections in acquired immunodeficiency syndrome (AIDS) patients. While effective for bacteria and fungi, mNGS requires protocol optimization for viral and tuberculosis detection.
Area of Science:
- Infectious Diseases
- Genomics
- Clinical Diagnostics
Background:
- Pulmonary infections pose a significant challenge in acquired immunodeficiency syndrome (AIDS) patients.
- Accurate and rapid pathogen identification is crucial for effective treatment and management.
- Conventional microbiological tests (CMT) have limitations in diagnosing complex infections in immunocompromised individuals.
Purpose of the Study:
- To evaluate the diagnostic performance of metagenomic next-generation sequencing (mNGS) for pulmonary infections in AIDS patients.
- To compare mNGS with conventional microbiological tests (CMT).
- To assess the pathogenicity of detected microorganisms using random forest analysis.
Main Methods:
- Bronchoalveolar lavage fluid (BALF) samples from 64 AIDS patients were analyzed.
- Samples were subjected to both mNGS and CMT.
- Random forest analysis was employed to determine pathogen significance.
Main Results:
- mNGS detected a broad spectrum of pathogens, including bacteria, fungi, and viruses, with higher sensitivity than CMT.
- Mixed infections were common, with Pneumocystis pneumonia (PCP) and bacterial coinfections frequently observed.
- Concordance with CMT varied, showing lower agreement for viral detection and Mycobacterium tuberculosis.
Conclusions:
- mNGS offers superior broad-spectrum pathogen detection for pulmonary infections in AIDS patients.
- Limitations exist in mNGS for diagnosing viral infections and tuberculosis, necessitating protocol refinement.
- mNGS serves as a valuable complementary diagnostic tool, advancing precision medicine in complex cases but requiring further clinical validation.
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