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. 2024 Dec 3;29(1):576.
doi: 10.1186/s40001-024-02180-0.

Analysis of coinfections in patients with hematologic malignancies and COVID-19 by next-generation sequencing of bronchoalveolar lavage fluid

Wenxiu Shu #  1 , Qianqian Yang #  1 , Jing Le  1 , Qianqian Cai  1 , Hui Dai  1 , Liufei Luo  1 , Jiaqi Tong  1 , Yanping Song  1 , Bingrong Chen  1 , Yaodong Tang  2 , Dian Jin  3
Affiliations

Analysis of coinfections in patients with hematologic malignancies and COVID-19 by next-generation sequencing of bronchoalveolar lavage fluid

Wenxiu Shu et al. Eur J Med Res. .

Abstract

Background: Coinfections in patients with coronavirus disease 2019 (COVID-19) affect patient prognosis. Patients with hematologic malignancies (HMs) are usually immunosuppressed and may be at high risk of coinfection, but few related data have been reported. Here, we conducted a retrospective study to explore coinfections in patients with HMs and COVID-19 by next-generation sequencing (NGS) of bronchoalveolar lavage fluid (BALF).

Methods: The data of hospitalized patients with pneumonia who underwent NGS analysis of BALF were reviewed. COVID-19 patients with HMs were enrolled in the HM group, and those without HMs were enrolled in the non-HM group. The coinfections of the two groups identified by NGS were analyzed.

Results: Fifteen patients were enrolled in the HM group, and 14 patients were enrolled in the non-HM group. The coinfection rates in the HM group and non-HM group were 80.0% and 85.7%, respectively. The percentage of coinfected bacteria in the HM group was significantly lower than that in the non-HM group (20.0% vs 71.4%, p = 0.005). The coinfection rates of fungi and viruses were 60.0% and 35.7%, respectively, in the HM group and 35.7% and 78.6%, respectively, in the non-HM group, with no significant differences. The most common coexisting pathogen in patients with HMs was Pneumocystis jirovecii (33.3%), and the most common coexisting pathogen in patients without HMs was human gammaherpesvirus 4 (50%). Coinfection with herpesviruses occurred frequently in both groups.

Conclusions: Our study showed that the majority of hospitalized patients with COVID-19 are likely to be co-infected with other pathogens. Pneumocystis jiroveci and herpesvirus are commonly coinfected pathogens in patients with HMs. Bacterial coinfection is rare in patients with HMs but is more common in patients without HMs.

Keywords: COVID-19; Coinfection; Hematologic malignancy; Next-generation sequencing.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Ethical Review Committee of Ningbo Medical Center Lihuili Hospital (approval No. YJZ2023SL2). The procedures used in this study adhere to the tenets of the Declaration of Helsinki. Informed consent was obtained from all subjects and/or their legal guardian(s). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient selection in this study. NGS: next-generation sequencing; BALF: bronchoalveolar lavage fluid; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; HM: hematologic malignancy
Fig. 2
Fig. 2
Heatmap of the pathogens and their sequence numbers detected by next-generation sequencing in patients with hematologic malignancies (A) and patients without hematologic malignancies (B). SARS-CoV-2: severe acute respiratory syndrome coronavirus 2
Fig. 3
Fig. 3
Comparison of coexisting pathogens between the HM and non-HM groups. A Overall coinfection, bacterial coinfection, fungal coinfection, and viral coinfection in the two groups. B Coinfection of bacteria in the two groups at the genus level. C Coinfection of fungus in the two groups at the genus level. D Coinfection of viruses in the two groups at the genus level. HM: hematologic malignancy
Fig. 4
Fig. 4
90 day survival in the HM and non-HM groups. HM: hematologic malignancy
Fig. 5
Fig. 5
Risk factors for severe COVID-19. ECOG: Eastern Co-operative Oncology Group; OR: odds ratio; CI: confidence interval
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