Invasive pulmonary aspergillosis (IPA) is one of the major causes of morbidity and mortality in immunocompromised patients such as
hematological malignancies,
hematopoietic stem cell transplantation, and solid
organ transplantation. The diagnosis of IPA in these patients is still difficult because it has no obvious specificity in clinical symptoms, signs and imaging, and test sensitivity of blood 1,3-β-d-glucan test,
galactomannan are low. Therefore, we still need to explore more diagnostic methods. In our study, via peripheral blood metagenomic next-generation sequencing (mNGS), five patients were tested positive for Aspergillus
DNA and then quickly diagnosed as IPA. Out of the 5 cases, 1 was proven and 4 were probable IPA. The underlying diseases of the 5 patients were
myelodysplastic syndrome (2 cases),
acute myeloid leukemia (2 cases), and
renal transplantation (1 case). Then they were diagnosed as IPA using other methods such as lung histopathology, bronchoalveolar lavage fluid (BALF) mNGS, and sputum culture or sputum mNGS. In case 1, sputum culture suggested Aspergillus flavus. In case 2, both Grocott
methenamine silver (GMS)
stain of lung histopathology and lung tissue mNGS suggested
Aspergillus infection. In cases 3 and 4, BALF-mNGS suggested
Aspergillus infection. In case 5, sputum mNGS suggested
Aspergillus infection. In conclusion, detecting the
cfDNA of Aspergillus via peripheral blood mNGS can be used to diagnose IPA and is a rapid and non-invasive diagnosis method.