Pulmonary coinfection of Mycobacterium tuberculosis and Tropheryma whipplei: a case report

Abstract

Background We diagnosed a clinical case of pulmonary infection involving Mycobacterium tuberculosis and Tropheryma whipplei in a patient with acute respiratory distress syndrome. The diagnosis was assisted by metagenomic next-generation sequencing of bronchoalveolar lavage fluid. Case presentation A 44-year-old Han Chinese inmate was transferred to the emergency department because of dry cough, chest tightness, and shortness of breath. The patient’s body temperature rose to 39.3 °C following empirical cephalosporin treatment for 1 week. The blood CD4+/CD8+ ratio was 0.7, suggesting immunodeficiency. Routine microbiological tests were performed, and tuberculosis interferon gamma release assays were positive. Mycobacterium tuberculosis polymerase chain reaction was also positive. Chest computed tomography scan revealed miliary nodules and ground-glass opacifications, which were in accordance with tuberculosis. To fully examine the etiology, we performed routine laboratory tests and metagenomic sequencing, the results of which indicated the presence of Mycobacterium tuberculosis and Tropheryma whipplei. We administered anti-tuberculosis regimen in combination with trimethoprim/sulfamethoxazole. The patient recovered, with chest computed tomography scan showing absorption of lesions. Conclusions Compared with traditional diagnostic methods such as culture and serology, metagenomic next-generation sequencing has the advantage of detecting a wide array of microorganisms in a single test and therefore can be used for clinical diagnosis of rare pathogens and microbial coinfections. It is particularly useful for immunocompromised patients as they are more prone to infection by opportunistic microorganisms.

Tropheryma whipplei detection by metagenomic next-generation sequencing in bronchoalveolar lavage fluid: A cross-sectional study

“…Moreover, we also found that immunocompromised patients were more likely to be diagnosed with pneumonia, suggesting that T. whipplei should be considered more as a pathogen when detected in BALF in immunocompromised patients with clinical symptoms. Mycobacterium tuberculosis complex and T. whipplei co-infection or detection were occasionally reported in other studies ( Lagier et al., 2016 ; Zhu et al., 2021 ). However, our study found that Mycobacterium tuberculosis complex was the most common pathogenic bacteria detected together, and a considerable number of patients (34.3%) were diagnosed as reactivation pulmonary tuberculosis.…”

Tropheryma whipplei detection by metagenomic next-generation sequencing in bronchoalveolar lavage fluid

“…Li et al reported a case of Severe pneumonia in adults caused by T.whipplei and Candida albicans infection [40] . Yan et al found that T.whipplei hide in an AIDS Patient With Pneumocystis Pneumonia [41] .The co-infection of Mycobacterium tuberculosis complex and T.whipplei has occasionally been reported in other studies [42][43] . And our study found that Klebsiella pneumoniae, Acinetobacter baumannii and Pneumocystis yersiniae were the most common pathogenic bacteria tested together.…”

Clinical feature analysis of pneumonia caused by Tropheryma Whipplei

“…Figure 2c [12] : Chest CT imaging shown diffuse miliary patchy high-density shadows in both lungs. Figure 2d [17] : Chest CT imaging shown groundglass high-density shadow in both lungs. Figure 2e [18] : Chest CT imaging shown patchy high-density shadow in the left lung and right lung lower lobe, showing bronchial shadows, and small bilateral pleural effusions.…”

“…The age, gender, underlying diseases, clinical presentations, laboratory examinations, pulmonary imaging , treatment strategy, and outcomes of patients were retrospectively collected [12][13][14][15][16][17][18][19][20][21][22] . The relevant pictures of the article have been authorized by the original author or publisher (Supplementary material 1).…”