Abstract：Objective To study the application value of metagenomic next-generation sequencing (mNGS) for pathogen detection in childhood agranulocytosis with fever. Methods A retrospective analysis was performed on the mNGS results of pathogen detection of 116 children with agranulocytosis with fever who were treated from January 2020 to December 2021. Among these children, 38 children with negative mNGS results were enrolled as the negative group, and 78 children with positive results were divided into a bacteria group (n=22), a fungal group (n=23), and a viral group (n=31). Clinical data were compared between groups. Results For the 116 children with agranulocytosis and fever, the median age was 8 years at diagnosis, the median turnaround time of mNGS results was 2 days, and the positive rate of mNGS testing was 67.2% (78/116). Compared with the negative group, the bacterial group had a higher procalcitonin level (P<0.05), the fungal group had higher level of C-reactive protein and positive rate of (1,3)-β-D glucan test/galactomannan test (P<0.05), and the fungal group had a longer duration of fever (P<0.05). Among the 22 positive microbial culture specimens, 9 (41%) were consistent with the mNGS results. Among the 17 positive blood culture specimens, 8 (47%) were consistent with the mNGS results. Treatment was adjusted for 28 children (36%) with the mNGS results, among whom 26 were cured and discharged. Conclusions The mNGS technique has a shorter turnaround time and a higher sensitivity for pathogen detection and can provide evidence for the pathogenic diagnosis of children with agranulocytosis and fever.
ZHU Shan,LIU Ying,LUO Hai-Yan et al. Application value of metagenomic next-generation sequencing for pathogen detection in childhood agranulocytosis with fever[J]. CJCP, 2022, 24(7): 753-758.
Li MJ, Chang HH, Yang YL, et al. Infectious complications in children with acute lymphoblastic leukemia treated with the Taiwan Pediatric Oncology Group protocol: a 16-year tertiary single-institution experience[J]. Pediatr Blood Cancer, 2017, 64(10): e26535. PMID: 28371256. DOI: 10.1002/pbc.26535.
Goldberg B, Sichtig H, Geyer C, et al. Making the leap from research laboratory to clinic: challenges and opportunities for next-generation sequencing in infectious disease diagnostics[J]. mBio, 2015, 6(6): e01888-15. PMID: 26646014. PMCID: PMC4669390. DOI: 10.1128/mBio.01888-15.
Simner PJ, Miller S, Carroll KC. Understanding the promises and hurdles of metagenomic next-generation sequencing as a diagnostic tool for infectious diseases[J]. Clin Infect Dis, 2018, 66(5): 778-788. PMID: 29040428. PMCID: PMC7108102. DOI: 10.1093/cid/cix881.
Long Y, Zhang Y, Gong Y, et al. Diagnosis of sepsis with cell-free DNA by next-generation sequencing technology in ICU patients[J]. Arch Med Res, 2016, 47(5): 365-371. PMID: 27751370. DOI: 10.1016/j.arcmed.2016.08.004.
Grumaz S, Grumaz C, Vainshtein Y, et al. Enhanced performance of next-generation sequencing diagnostics compared with standard of care microbiological diagnostics in patients suffering from septic shock[J]. Crit Care Med, 2019, 47(5): e394-e402. PMID: 30720537. PMCID: PMC6485303. DOI: 10.1097/CCM.0000000000003658.
