The application of metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid in dissecting pulmonary infections in patients with CTD-ILD
Authors' conclusion
Pulmonary infections are common in patients with CTD-ILD. mNGS has the advantages of rapidly detecting more bacteria, viruses and P. jirovecii. However, infection with aspergillus should be more rigorously evaluated in combination with CMTs.
Study context
- Population
- Patients with CTD-associated ILD evaluated for suspected pulmonary infection by mNGS of bronchoalveolar lavage fluid (BALF); majority (66.67%) IIM-ILD36 infection, 12 non-infectious
- Participants
- 48 patients
- Comparison
- mNGS of BALF vs conventional microbiological tests (CMTs) for diagnosis of pulmonary infection
- Outcome
- Performance of mNGS vs CMTs in diagnosis of pulmonary infection
Methodological detailsretrospective identification of patients evaluated by mNGS of BALF, clinical composite assessment as reference
- Retrospective identification of patients evaluated by mNGS of BALF
- Clinical composite assessment as reference
Performance
As reported in the abstract
Pathogen identification, mNGS vs CMTs
- mNGS superior in identifying bacteria, viruses and P. jirovecii
- CMTs identified more aspergillus and cryptococcus
Further findings
Classification by clinical composite assessment
- Pulmonary infection
- 36
- Non-infectious disease progression
- 12
- Most common causative pathogens: Cytomegalovirus (CMV), P. jirovecii and aspergillus
Predictors of pulmonary infection in CTD-ILD
- Decreased albumin, reduced IgM and increased lactate dehydrogenase (LDH) predicted pulmonary infection
Predictors of P. jirovecii infection
- Short disease duration, decreased lymphocytes and reduced immunoglobulins predictive
Features of aspergillus infection
- Older age and increased serum ferritin more common
Original publication
The application of mNGS of bronchoalveolar lavage fluid in dissecting pulmonary infections in patients with CTD-ILD. Rheumatology (Oxford). Published 9 November 2025. doi:10.
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