Severe pneumonia in adults caused by Tropheryma whipplei and Candida sp. infection: a 2019 case series

Li, Wei; Zhang, Qun; Xu, Yanling; Zhang, Xiyue; Huang, Qian; Su, Zheng

doi:10.1186/s12890-020-01384-4

Cited by 19 publications

(14 citation statements)

References 21 publications

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“…Our study also confirm that T. whipplei is an etiologic pathogen in acute respiratory infections (Lagier et al, 2017). T. whipplei could be co-infected with Pneumocystis jirovecii and Candida albicans, as reported in previous cases (Li et al, 2021;Yan et al, 2021), or leaded to pulmonary infection alone (Guo e t a l . , 2 0 2 1 ) .…”

Section: Discussionsupporting

confidence: 89%

“…Our study also confirm that T. whipplei is an etiologic pathogen in acute respiratory infections ( Lagier et al., 2017 ). T. whipplei could be co-infected with Pneumocystis jirovecii and Candida albicans , as reported in previous cases ( Li et al., 2021 ; Yan et al., 2021 ), or leaded to pulmonary infection alone ( Guo et al., 2021 ). 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.…”

Section: Discussionsupporting

confidence: 61%

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

Lin

Wang

Qiu

et al. 2022

Front. Cell. Infect. Microbiol.

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Tropheryma whipplei is the bacterium associated with Whipple’s disease (WD), a chronic systemic infectious disease primarily involving the gastrointestinal tract. T. whipplei can also be detected in different body site of healthy individuals, including saliva and feces. Traditionally, Tropheryma whipplei has a higher prevalence in bronchoalveolar lavage fluid (BALF) of immunocompromised individuals. Few studies have explored the significance of the detection of T. whipplei in BALF. Herein, we retrospectively reviewed 1725 BALF samples which detected for metagenomic next-generation sequencing (mNGS) from March 2019 to April 2022 in Zhuhai, China. Seventy BALs (70/1725, 4.0%) from 70 patients were positive for T. whipplei. Forty-four patients were male with an average age of 50 years. The main symptoms included cough (23/70), expectoration (13/70), weight loss (9/70), and/or dyspnea (8/70), but gastrointestinal symptoms were rare. Chronic liver diseases were the most common comorbidity (n=15, 21.4%), followed by diabetes mellitus (n=13, 18.6%). Only nine patients (12.9%) were immunocompromised. Twenty-four patients (34.3%) were finally diagnosed with reactivation tuberculosis and 15 patients (21.4%) were diagnosed with lung tumors, including 13 primary lung adenocarcinoma and two lung metastases. Fifteen patients (21.4%) had pneumonia. Among the 20 samples, T. whipplei was the sole agent, and Mycobacterium tuberculosis complex was the most common detected other pathogens. Among the non-tuberculosis patients, 31 (31/46, 67.4%) had ground glass nodules or solid nodules on chest CT. Our study indicates that T. whipplei should be considered as a potential contributing factor in some lung diseases. For non-immunocompromised patients, the detection of T. whipplei also needs attention. The mNGS technology improves the detection and attention of rare pathogens. In the future, the infection, colonization, and prognosis of T. whipplei in lung still need to be studied.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 61%

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

Lin

Wang

Qiu

et al. 2022

Front. Cell. Infect. Microbiol.

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“…Our case is the first diagnosed case of pulmonary cavity caused by Tropheryma whipplei . In addition to our case, we identified 19 patients with lung parenchymal involvement in the literature [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. Their clinical, radiologic, and pathological features were provided in the Table S1.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary parenchymal involvement caused by Tropheryma whipplei

Zhang

2021

Open Medicine

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We report a 26-year-old man with left chest pain for 4 days. His chest CT showed a cavity in the left upper lung. Tuberculosis was suspected first, but metagenomics next generation sequencing (mNGS) in bronchoalveolar lavage fluid only detected Tropheryma whipplei. Tropheryma whipplei is the pathogen of Whipple’s disease. The most frequently involved organs are the eyes, heart, and central nervous system. Pulmonary parenchymal involvement is rare. To our knowledge, this is the first reported case of pulmonary cavity caused by Tropheryma whipplei. Nineteen cases of pulmonary parenchymal involvement were found by literature search. The most common respiratory symptom was cough, followed by dyspnea/breathlessness and chest pain. The most common finding in chest imaging was pulmonary nodules, followed by interstitial changes and patchy infiltration. Our case and literature review highlighted that Tropheryma whipplei infection should be considered in the differential diagnosis of pulmonary cavity, pulmonary nodules, interstitial changes, and patchy infiltration. mNGS is helpful to improve diagnosis rate.

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“…[ 42 ] In addition to monomicrobial infection, TW has been found to cause severe pneumonia due to co-infection with opportunistic species. [ 46 ] Chronic pulmonary disease has distinctive clinical manifestations. In these cases, lung involvement appears as an interstitial or granulomatous lung disease that may mimic pulmonary sarcoidosis or fungal infections.…”

Section: Discussionmentioning

confidence: 99%

Whipple’s disease review, prevalence, mortality, and characteristics in the United States: A cross-sectional national inpatient study

et al. 2022

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Whipple's disease is a rare multiorgan systemic disease caused by Tropheryma whipplei infection that may present with a wide range of signs and symptoms. This study aim to comprehensively review and determine the inpatient prevalence, mortality, risk factors, and reasons for hospitalization of patients with Whipple's disease. ICD-10 codes were used to identify admissions with Whipple's disease during the years 2016 to 2018. Characteristics of admissions with and without Whipple's disease were compared. The most common reasons for hospitalization were identified in admissions with Whipple's disease. The prevalence of Whipple's disease was 4.6 per 1 million hospitalizations during the study period. Whipple's disease admissions were significantly older than other hospitalizations, with a mean age of 60.2 ± 1.6 years compared to 50.0 ± 0.1. Males were more likely to have Whipple's disease and represented approximately two-thirds of hospitalizations. A disproportionate number of admissions occurred in the Midwest. Patients with Whipple's disease were most commonly admitted for gastrointestinal disease, followed by systemic infection, cardiovascular/circulatory disease, musculoskeletal disease, respiratory disease, and neurological disease. High mortality was seen in admissions for central nervous system (CNS) disease. Whipple's disease has heterogeneous presentations for inpatient admissions, and disproportionately affects older males. High hospitalization rates in the Midwest support environmental and occupational disease transmission likely from the soil. Hospitalists should be aware of the various acute, subacute, and chronic presentations of this disease, and that acute presentations may be more common in the inpatient setting.

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Severe pneumonia in adults caused by Tropheryma whipplei and Candida sp. infection: a 2019 case series

Cited by 19 publications

References 21 publications

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

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

Pulmonary parenchymal involvement caused by Tropheryma whipplei

Whipple’s disease review, prevalence, mortality, and characteristics in the United States: A cross-sectional national inpatient study

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