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

Wei Li,Qun Zhang,Xiyue Zhang,Qian Huang,Yanling Xu,Zhenzhong Su

doi:10.1186/s12890-020-01384-4

Wei Li, Qun Zhang + Show 4 more

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https://doi.org/10.1186/s12890-020-01384-4

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Abstract

BackgroundWhipple’s disease is a chronic infectious disease caused by the Gram-positive bacterium Tropheryma whipplei (TW), which not only affects the gastrointestinal tract and causes malabsorption of nutrients, but several other systems, such as the cardiovascular system, central nervous system, the joints, and the vascular system, can also be simultaneously involved. The aim of this report was to be able to alert the clinician to severe pneumonia caused by TW combined with Candida sp.Case presentationThe case study was conducted on patients in September and November 2019. After routine examination and treatment, the results were not satisfactory. A bronchoalveolar lavage (BAL) using metagenomics next-generation sequencing was conducted on two adults who presented with fever, cough, and progressive dyspnea and who had no history of gastrointestinal symptoms, immunodeficiency diseases, or use of immunosuppressive agents. TW and Candida sp. were detected in in BAL.ConclusionsThis is a report of life-threatening pneumonia caused by TW combined with Candida sp. in a Chinese population.

Highlights

Whipple’s disease is a chronic infectious disease caused by the Gram-positive bacterium Tropheryma whipplei (TW), which affects the gastrointestinal tract and causes malabsorption of nutrients, but several other systems, such as the cardiovascular system, central nervous system, the joints, and the vascular system, can be simultaneously involved
This is a report of life-threatening pneumonia caused by TW combined with Candida sp. in a Chinese population
Given that the broad-spectrum antibiotics had no effect and that the bacteria culture was negative, we considered using antibiotics against TW; we adjusted the treatment protocol to include a combination of sulfamethoxazole tablets and meropenem and antifungal therapy

Summary

Introduction

Whipple’s disease is a chronic infectious disease caused by the Gram-positive bacterium Tropheryma whipplei (TW), which affects the gastrointestinal tract and causes malabsorption of nutrients, but several other systems, such as the cardiovascular system, central nervous system, the joints, and the vascular system, can be simultaneously involved. The aim of this report was to be able to alert the clinician to severe pneumonia caused by TW combined with Candida sp. A bronchoalveolar lavage (BAL) using metagenomics next-generation sequencing was conducted on two adults who presented with fever, cough, and progressive dyspnea and who had no history of gastrointestinal symptoms, immunodeficiency diseases, or use of immunosuppressive agents. WD is a chronic and rare systemic infectious disease affecting the gastrointestinal tract and causing arthritis and weight loss[2]. The common symptoms are fever, abdominal pain, diarrhea, weight loss, and joint pain.

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