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Recommendations for Pathogen Diagnostic Testing in Adult Respiratory Infections
Adult respiratory infections present in diverse forms, with distinct pathogen profiles varying by infection type and underlying conditions. In routine clinical practice, diagnosis should be based on patients' clinical signs and symptoms, combined with imaging, traditional microbiological, immunological, and molecular biological testing techniques (table below). Rapid and precise diagnosis should be made according to corresponding testing criteria. Currently, there remain several urgent issues to be resolved in the clinical application of molecular diagnostic techniques, particularly regarding the correct interpretation of clinical results. Different testing technologies provide results with varying clinical significance. Their combined application can further improve the sensitivity and specificity of pathogen detection, better explain disease progression, and monitor treatment effectiveness.
Table: Recommended Technologies for Adult Respiratory Infection Pathogens
| Type of Infection | Pathogens | Nucleic Acid Testing Methods | Specimen Types | Transport Requirements |
| Acute Upper Respiratory Tract Infection | Primary: Viruses (Rhinovirus, RSV, Influenza virus, Coronavirus); Rare: Bacteria (Streptococcus pyogenes, Corynebacterium diphtheriae, Haemophilus haemolyticus, Neisseria gonorrhoeae); Anaerobes in purulent infections |
Single-target real-time PCR, Multiplex real-time PCR, Microfluidic chip, mNGS, tNGS | Oral swab, Oropharyngeal swab, Nasopharyngeal swab, Nasopharyngeal aspirate, Nasopharyngeal lavage, Maxillary sinus aspirate | Viruses: Viral transport medium, 2-8°C; Bacteria: Room temperature, ≤2h |
| Tracheobronchitis | RSV, Parainfluenza virus, Human metapneumovirus, Adenovirus, Mycoplasma pneumoniae, Chlamydophila pneumoniae | Single-target real-time PCR, Multiplex real-time PCR, Microfluidic chip | Nasopharyngeal swab, Nasopharyngeal aspirate, Nasopharyngeal lavage | Viral transport medium, 2-8°C |
| Community-Acquired Pneumonia | Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, Respiratory viruses, Legionella spp., Nocardia spp., Actinomyces spp. | Multiplex real-time PCR, Microfluidic chip, mNGS, tNGS | Sputum, Induced sputum, Tracheal aspirate, BALF, Lung biopsy tissue, Pleural fluid | Bacteria: Room temperature, ≤2h; Viruses: Viral transport medium, 2-8°C |
| Hospital-Acquired/Ventilator-Associated Pneumonia | MDR Gram-negative bacteria (Klebsiella pneumoniae, E. coli, Acinetobacter baumannii, Pseudomonas aeruginosa, other Enterobacterales, Stenotrophomonas maltophilia, Burkholderia cepacia); MRSA | Multiplex real-time PCR, Microfluidic chip, mNGS and tNGS as needed | Sputum, Induced sputum, Tracheal aspirate, BALF, Lung biopsy tissue, Pleural fluid | Room temperature, ≤2h |
| COPD Exacerbation | Common: Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae, Pseudomonas aeruginosa, Enterobacterales; Rare: Chlamydophila pneumoniae, Mycoplasma pneumoniae, Legionella spp., Staphylococcus aureus | Multiplex real-time PCR, Microfluidic chip, mNGS, tNGS | Sputum, Induced sputum, Tracheal aspirate, BALF | Room temperature, ≤2h |
| Pulmonary Tuberculosis | Mycobacterium tuberculosis; Differentiation from NTM | Real-time PCR, Microfluidic chip, tNGS, mNGS | Sputum, Induced sputum, Tracheal aspirate, BALF, Lung biopsy tissue, Pleural fluid | Room temperature, ≤2h |
| Malignancy Patients | Common respiratory pathogens plus higher risk of: ESBL-producing bacteria, Nocardia spp., MTB, NTM, CMV, Aspergillus, Cryptococcus, Pneumocystis jirovecii | Single-target real-time PCR, Multiplex real-time PCR, Microfluidic chip, NGS, mNGS | Sputum, Induced sputum, Tracheal aspirate, BALF, Lung biopsy tissue, Pleural fluid | Room temperature, ≤2h |
| Stem Cell/Organ Transplant Recipients | Common respiratory pathogens plus higher risk of: MTB, CMV, Aspergillus, Cryptococcus, Pneumocystis jirovecii | Single-target real-time PCR, Multiplex real-time PCR, Microfluidic chip, NGS, mNGS | Sputum, Induced sputum, Tracheal aspirate, BALF, Lung biopsy tissue, Pleural fluid | Room temperature, ≤2h |
| Immune-Related Disease Patients | Multiple or sequential infections possible, including Aspergillus, Candida, CMV, Pneumocystis jirovecii | Single-target real-time PCR, Multiplex real-time PCR, Microfluidic chip, NGS, mNGS | Sputum, Induced sputum, Tracheal aspirate, BALF, Lung biopsy tissue, Pleural fluid | Room temperature, ≤2h |
| HIV-Infected Patients | CD4+T cells <200/mL or AIDS: Higher risk of Pneumocystis, MTB, Cryptococcus; Normal CD4 count: Higher risk of Streptococcus pneumoniae, Haemophilus influenzae, Aerobic gram-negative bacilli, MTB |
Single-target real-time PCR, Multiplex real-time PCR, Microfluidic chip, NGS, mNGS | Sputum, Induced sputum, Tracheal aspirate, BALF, Lung biopsy tissue, Pleural fluid | Room temperature, ≤2h |
With the numerous pathogen detection technologies available today, selecting appropriate testing methods to better address clinical issues has become a crucial topic in achieving precision diagnosis and treatment of infectious diseases.
Mantacc continues to innovate in enriching its flocked swab product portfolio and providing comprehensive solutions for multiple testing scenarios, striving to meet dynamic market demands. For different clinical applications, Mantacc offers a range of flocked swabs based on varying collection requirements, providing integrated solutions for precise clinical diagnostics.
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