Comprehensive Pathogen Spectrum Analysis Using mNGS in AIDS Patients With Pulmonary Infections: Diagnostic Value and Clinical Implications.

BackgroundThis study evaluated the diagnostic value of metagenomic next-generation sequencing (mNGS) in identifying pathogens causing pulmonary infections in 64 acquired immunodeficiency syndrome (AIDS) patients at Beijing Ditan Hospital.MethodsBronchoalveolar lavage fluid (BALF) samples were analyzed using mNGS and conventional microbiological tests (CMT). Diagnostic performance was compared, and random forest analysis was used to assess pathogenicity.ResultsmNGS detected 45 pathogens, including 14 viruses, 3 fungi, and 28 bacteria. Compared with CMT, mNGS showed higher sensitivity for detecting bacteria (75.0% vs 29.17%), fungi (45.0% vs 16.67%), and viruses (80.0% vs 20.83%). Mixed infections were identified in 55.2% of cases, predominantly Pneumocystis pneumonia (PCP) with bacterial coinfections. However, mNGS had lower concordance with CMT for viruses (24.1% for cytomegalovirus) and Mycobacterium tuberculosis (75.0%). Random forest analysis highlighted Candida albicans and Stenotrophomonas maltophilia as highly pathogenic.ConclusionsWhile mNGS demonstrated superior broad-spectrum detection, its limitations in viral and TB diagnosis underscore the need for optimized protocols. The study supports mNGS as a complementary tool for diagnosing complex pulmonary infections in AIDS patients, enhancing precision medicine but requiring further refinement for widespread clinical adoption.