{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T19:06:46Z","timestamp":1788376006275,"version":"build-2803163510"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diagnosing invasive pulmonary aspergillosis (IPA) in non-neutropenic patients is challenging because of non-specific manifestations and limited diagnostic tools. Targeted next-generation sequencing (tNGS) of bronchoalveolar lavage fluid (BALF) enables rapid pathogen detection; however, its capacity for quantitative assessment of fungal load remains unclear. This study integrated BALF-tNGS fungal load with host risk factors to develop a diagnostic nomogram for IPA in non-neutropenic patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Non-neutropenic adults with suspected IPA were retrospectively enrolled at three tertiary hospitals (December 2020\u2013December 2024). IPA was classified according to consensus definitions. Normalized Aspergillus reads from BALF-tNGS were stratified into low, medium, and high tiers. Clinical, radiological, and microbiological variables were analyzed, and a multivariable logistic regression model was built and internally validated via bootstrapping. Diagnostic performance was assessed using receiver operating characteristic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 238 patients, 134 had IPA and 104 had non-IPA. Compared with non-IPA cases, patients with IPA had higher rates of diabetes (73.9%), corticosteroid exposure (87.3%), bacterial co-infection (94.8%), and intensive care unit (ICU) admission (72.4%) (all\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.01). IPA prevalence peaked in the medium-load group (75.4%) compared with the low-load (36.7%) and high-load (38.3%) groups (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). Seven independent predictors,\n                      <jats:italic>Aspergillus<\/jats:italic>\n                      load, diabetes, corticosteroid exposure, bacterial co-infection, ICU admission, nodular shadow, and positive BALF culture, were incorporated into the model, which showed excellent discrimination (AUC = 0.966; sensitivity, 91.8%; specificity, 95.2%) and good calibration.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Integrating BALF-tNGS\u2013derived normalized\n                      <jats:italic>Aspergillus<\/jats:italic>\n                      reads with host factors substantially improves differentiation of IPA from colonization in non-neutropenic patients. This semi-quantitative framework supports early, individualized antifungal decision-making and merits external validation.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1739837","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T06:50:26Z","timestamp":1770879026000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Integrative diagnosis of invasive pulmonary aspergillosis in non-neutropenic patients using BALF-tNGS\u2013derived Aspergillus load and host risk factors: a multicenter study"],"prefix":"10.3389","volume":"16","author":[{"given":"Furui","family":"Liu","sequence":"first","affiliation":[{"name":"The First School of Clinical Medicine, Ningxia Medical University","place":["Yinchuan, Ningxia, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bofei","family":"Liu","sequence":"additional","affiliation":[{"name":"The First School of Clinical Medicine, Ningxia Medical University","place":["Yinchuan, Ningxia, China"]},{"name":"The Fourth People\u2019s Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, Ningxia, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinyan","family":"Wang","sequence":"additional","affiliation":[{"name":"The Fourth People\u2019s Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, Ningxia, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhifeng","family":"Wang","sequence":"additional","affiliation":[{"name":"The Third People\u2019s Hospital of Ningxia","place":["Yinchuan, Ningxia, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenyan","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, General Hospital of Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonghong","family":"Yang","sequence":"additional","affiliation":[{"name":"The First School of Clinical Medicine, Ningxia Medical University","place":["Yinchuan, Ningxia, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenling","family":"Chen","sequence":"additional","affiliation":[{"name":"The First School of Clinical Medicine, Ningxia Medical University","place":["Yinchuan, Ningxia, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, General Hospital of Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Feng","sequence":"additional","affiliation":[{"name":"The Third People\u2019s Hospital of Ningxia","place":["Yinchuan, Ningxia, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinyuan","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, General Hospital of Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3390\/genes14081643","article-title":"Nucleic acids persistence-benefits and limitations in forensic genetics","volume":"14","author":"\u017barczy\u0144ska","year":"2023","journal-title":"Genes (Basel)."},{"key":"B2","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1086\/323335","article-title":"Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus","volume":"34","author":"Ascioglu","year":"2002","journal-title":"Clin. 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