Huang JJ, Zhang SS, Liu ML, Yang EY, Pan Y, Wu J. Next-generation sequencing technology for the diagnosis of Pneumocystis pneumonia in an immunocompetent female: A case report. World J Clin Cases 2023; 11(18): 4425-4432 [PMID: 37449225 DOI: 10.12998/wjcc.v11.i18.4425]
Corresponding Author of This Article
Jing Wu, PhD, Associate Professor, Intensive Care Unit, Guizhou Provincial People's Hospital, No. 83 Zhongshan East Road, Guiyang 550000, Guizhou Province, China. saidiny1120@qq.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jing-Ji Huang, The Second Clinical Medical College, Guizhou University of Traditional Chinese Medicine, Guiyang 550000, Guizhou Province, China
Song-Song Zhang, Man-Li Liu, En-Yu Yang, Yu Pan, Jing Wu, Intensive Care Unit, Guizhou Provincial People's Hospital, Guiyang 550000, Guizhou Province, China
Author contributions: Huang JJ and Wu J contributed to manuscript writing; Zhang SS and Liu ML contributed to collection of clinical data; Yang EY and Pan Y contributed to data analysis and production of charts; all authors have read and approved the final manuscript.
Supported bythe National Natural Science Foundation of China, No. 81860273; the Guizhou Provincial Science and Technology Projects, No. QKHJC-ZK[2022]-260; the Science and Technology Fund of Guizhou Provincial Health Commission, No. gzwkj2021-320; and Guizhou Provincial People's Hospital National Natural Science Foundation, No. [2018]5764-09.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing Wu, PhD, Associate Professor, Intensive Care Unit, Guizhou Provincial People's Hospital, No. 83 Zhongshan East Road, Guiyang 550000, Guizhou Province, China. saidiny1120@qq.com
Received: April 4, 2023 Peer-review started: April 4, 2023 First decision: May 12, 2023 Revised: May 25, 2023 Accepted: May 30, 2023 Article in press: May 30, 2023 Published online: June 26, 2023 Processing time: 83 Days and 15.7 Hours
Abstract
BACKGROUND
Pneumocystis pneumonia (PCP) is a serious fungal infection usually seen in patients with human immunodeficiency virus, and it is more frequently found and has a high fatality rate in immunocompromised people. Surprisingly, it rarely occurs in immunocompetent patients. However, the clinical diagnosis of this pathogen is made more difficult by the difficulty of obtaining accurate microbiological evidence with routine tests. This case reports a PCP patient with normal immune function who was diagnosed through next-generation sequencing (NGS).
CASE SUMMARY
A 23-year-old female who had no special disease in the past was admitted to the hospital with a persistent fever and cough. Based on the initial examination results, the patient was diagnosed with bipulmonary pneumonia, and empirical broad-spectrum antibiotic therapy was administered. However, due to the undetermined etiology, the patient's condition continued to worsen. She was transferred to the intensive care unit because of acute respiratory failure. After the diagnosis of Pneumocystis jirovecii infection through NGS in bronchoalveolar lavage fluid and treatment with trimethoprim/sulfamethoxazole and caspofungin, the patient gradually recovered and had a good prognosis.
CONCLUSION
This case emphasizes that, for patients with normal immune function the possibility of PCP infection, although rare, cannot be ignored. NGS plays an important role in the diagnosis of refractory interstitial pneumonia and acute respiratory failure.
Core Tip: Although Pneumocystis pneumonia (PCP) in immunocompetent patients is rare, it should be considered in infected patients with sudden onset of respiratory failure. However, using routine clinical examination, it can be challenging to differentiate between colonizing bacteria and subclinical infections. Instead of traditional laboratory techniques, next-generation sequencing (NGS) was used to make the diagnosis in the current case report. Early diagnosis and fast treatment helped to avoid ineffective treatments and improve the prognosis. This case emphasized that PCP can arise in immunocompetent patients, and NGS may be an effective test method for the quick and accurate diagnosis of PCP.
