Trichomonas Empyema With Respiratory Failure

Wang, Hua-Kung; Jerng, Jih-Shuin; Su, Kang‐Yi; Chang, Shan‐Chwen; Yang, Pan‐Chyr

doi:10.4269/ajtmh.2006.75.1234

Cited by 21 publications

(12 citation statements)

References 21 publications

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“…Indeed, in these two clinical contexts, the alveolar lumens are obliterated by fungi in the case of PCP or by fibrin and cellular debris in the case of ARDS. The proliferation of trichomonads in the pleural cavity has been reported in 16 cases of empyema, including that reported by Wang et al (20), and appeared to depend on the presence of bacterial species in addition to anaerobic conditions (10,14,20). This is due to the fact that these parasites are known to feed on bacteria.…”

Section: Case Reportmentioning

confidence: 78%

Molecular Characterization of a New Tetratrichomonas Species in a Patient with Empyema

et al. 2009

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A new Tetratrichomonas species was identified by molecular and phylogenetic approaches in the pleural fluid from a patient with encysted empyema leading to dyspnea. This observation raised the questions of the real prevalence of pulmonary trichomonosis in humans, the zoonotic potential of trichomonads, and the existence of human-host-adapted strains. CASE REPORTA 40-year-old woman was admitted to the emergency unit with a bacterial infection and a history of fever, fatigue, vomiting, and respiratory distress for 2 weeks before admission. On physical examination, the patient was irritable with dyspnea. Her vital signs were as follows: temperature, 39.2°C; blood pressure, 168/81 mm Hg; heart rate, 110 beats/min; respiration, 30 breaths/min. A chest X-ray followed by a computed tomography scan revealed encysted empyema of the right lung with a large pleural effusion (Fig. 1A). Foul-smelling and purulent pleural fluid was removed from the right chest cavity by thoracentesis. Examination of the pleural fluid showed numerous motile and flagellated protozoa, which were provisionally identified as trichomonads by their morphological characteristics, including form, size, and motility. These flagellates were not cultured, and their identification was confirmed by microscopic examination of May-Grünwald-Giemsa-and Merthiolateiodine-Formalin (MIF)-stained smears (Fig. 1B). Moreover, this pleural fluid was used for subsequent molecular characterization of these protozoa. Bacteriological cultures of the fluid yielded gram-positive cocci. On day 2, a chest tube was inserted for drainage of the right pleura and fibrinolytic therapy with urokinase, and mechanical ventilation was instituted. Pleural fluid was drained and was positive for Streptococcus constellatus and Streptococcus gordonii, both anaerobic and aerobic bacteria, and the anaerobic bacterium Prevotella sp. in addition to the trichomonad species mentioned above. Antibiotherapy with amoxicillin (amoxicilline) was continued, and treatment with metronidazole (Flagyl) was started. On day 10, the patient suffered from diarrhea with the emergence of Clostridium difficile. Hence, the use of metronidazole was delayed and the patient was treated with vancomycin per os in addition to amoxicillin. On day 18, a follow-up chest computed tomography scan showed partial clearing of the pleural effusion. Consequently, the patient did not require further surgical cleaning of the pleural cavity. On day 24, the patient was successfully weaned from the ventilator, and by day 26, her general health condition had improved and she presented neither fever nor dyspnea.In order to identify the trichomonad species involved in this case report, DNA was extracted from pleural fluid using the High Pure PCR template preparation kit (Roche Applied Science, Mannheim, Germany) according to the manufacturer's protocol. In a first step, the internal transcribed spacer 1 (ITS1)-5.8S rRNA-ITS2 region was amplified as described previously (6, 12). PCR was carried out with a 50-l volume according to the st...

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Section: Case Reportmentioning

confidence: 78%

Molecular Characterization of a New Tetratrichomonas Species in a Patient with Empyema

et al. 2009

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“…Li te ratür de de ol gu mu za ben zer şekil de tri ko mo nas la rın ta nı sı ve tip len di ril me sin de ço ğun luk la mor fo lo jik bul gu lar göz önün de tu tul muş tur. 3,5,6 Tri ko mo nasla rın ile ri iden ti fi kas yo nun da da ha gü ve ni lir olan kül tür, se ro lo jik ve mo le kü ler yön tem ler ise ol gumuz da ya pı la ma mış tır. Ol gu muz da tri ko mo nas tanı sı or ni da zo le te da vi si baş lan dık tan üç gün son ra ko nul muş ve bu ne den le ağız içi, bal gam ve ya vagi nal ör nek le rin de tri ko mo nas ko lo ni zas yo nu araş-tı rıl ma mış tır.…”

Section: Erdoğan Ve Arkunclassified

“…Ula şı la bi len dokuz ol - Infectious Diseases Erdoğan et al gu su nu mu Tab lo 1'de özet len miş tir. [3][4][5][6][7][8][9][10][11] Bu ol gu ların Yedisinde eş lik en az bir bak te ri kül tür de üre tilmiş ve bi ri sin de ise ab se nin kül tü rün de üre ti le meme si ne rağ men gram bo ya ma sın da gram po zi tif kok ve gram ne ga tif bak te ri ler gös te ril miştir.…”

Section: Erdoğan Ve Arkunclassified

“…Li te ra tür de bil di ri len ol gu la rın te da vi si ne met ra ni da zol da ek len miş tir. [4][5][6][7][8][9][10][11][12] Has ta mı zın ta kibin de pi pe ra si lin/ta zo bak tam ve met ro ni da zol teda vi si al tın day ken tü bün ye rin de çık ma sı so nu cu gö ğüs du va rın da nek ro ti zan fa si it ge liş miş tir. Tekrar la yı cı cer ra hi deb rit man uy gu lan mış ve deb ritman son ra sı alı nan ör nek ler de üre me sap tan mamış tır.…”

Section: Erdoğan Ve Arkunclassified

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Empyema Caused by Micrococcus luteus, Prevotella and Trichomonas: A Case Report and Review

Erdoğan¹,

Can²,

Demirbilek³

et al. 2011

Turkiye Klinikleri J Med Sci

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“…Concerning pleural empyema with T. tenax, 15 cases have been reported to date (13). Usually, T. tenax is found as a commensal of the human oral cavity in those with poor oral hygiene.…”

Section: Contribution Of Pcr Analysis To Diagnosis Of Trichomoniasismentioning

confidence: 99%

Two Unusual Occurrences of Trichomoniasis: Rapid Species Identification by PCR

et al. 2008

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PCR analysis in two unusual occurrences of trichomoniasis, trichomonal empyema due to Trichomonas tenax and Trichomonas vaginalis in an infant urine sample, allowed us to obtain rapid and accurate trichomonad species identification. The weak sensitivity of wet preparations and the low viability of the flagellates can be remedied by the PCR method. CASE REPORTS Case 1. A 3-month-old girl was brought to the hospital by her parents because of aggravated respiratory distress and difficulty in eating. Physical examination revealed fever (38°C), mild inflammatory syndrome (C-reactive protein, 22 mg/liter), diffuse sibilants, and congestion. A chest radiograph revealed thoracic distension. Urine and stool samples were sent to the laboratory. Whereas the stool analysis was negative, the urine analysis was positive for Trichomonas vaginalis twice (Fig. 1). PCR analysis was carried out on urine, stool, and saliva. The urine sample was found positive for T. vaginalis. Genital examination of the infant revealed no abnormalities: absence of erythema, indurations, or skin breakdown of the labia or perineal area. The child was successfully treated with metronidazole (30 mg/kg of body weight/day) for 3 days. The respiratory distress was managed with salbutamol aerosol, respiratory physiotherapy, and rhinopharyngeal disinfection. To explore the source of the contamination, the mother underwent a vaginal examination in a private laboratory, which was negative for T. vaginalis.Case 2. A 33-year-old woman was admitted to the intensive cardiac surgical care unit for urgent cardiac transplantation. On day 9 (D9) postgraft, the patient became dyspneic and a chest radiograph showed a pneumothorax of the right lung. The patient was treated with vancomycin-cefotaxime after fluid drainage. As pain and dyspnea persisted, a chest scan was performed on D14 and demonstrated a right pneumothorax with pleural effusion. Pleural fluid was drained and was positive for Corynebacterium sp., Prevotella oralis, Peptostreptococcus sp., and Streptococcus sp. Antibiotherapy was switched to amoxicillin-clavulanic acid. On D19, a new chest scan showed a right hydropneumothorax with inflammatory syndrome (Creactive protein, 335 mg/liter), and a surgical cleaning of the pleural cavity was decided upon. Microscopic analysis of the pleural liquid was positive for flagellated motile parasites identified as Trichomonas tenax by their size and morphology (Fig. 2). PCR was carried out on pleural fluid, bronchoalveolar fluid, saliva, sputum, and stool. Pleural fluid, sputum, and bronchoalveolar fluid were positive for T. tenax. The anti-infection treatment was changed to piperacillin-tazobactam and metronidazole, which were rapidly followed by the clearance of the parasite.Material and methods for PCR analysis. DNA was extracted from bronchoalveolar fluid, saliva, sputum, and urine using the QIAamp DNA mini kit (Qiagen, Courtaboeuf, France) and from stool using the QIAamp DNA stool minikit according to the manufacturer's instructions, except that DNA was eluted f...

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Trichomonas Empyema With Respiratory Failure

Cited by 21 publications

References 21 publications

Molecular Characterization of a New Tetratrichomonas Species in a Patient with Empyema

Molecular Characterization of a New Tetratrichomonas Species in a Patient with Empyema

Empyema Caused by Micrococcus luteus, Prevotella and Trichomonas: A Case Report and Review

Two Unusual Occurrences of Trichomoniasis: Rapid Species Identification by PCR

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