Empyema Caused by Trichomonas

Lewis, Kevin; Doherty, Dennis E.; Ribes, Julie A.; Seabolt, John P.; Bensadoun, Eric

doi:10.1378/chest.123.1.291

Cited by 42 publications

(41 citation statements)

References 6 publications

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“…Transmission is through saliva, droplet spray, and kissing or use of contaminated dishes and drinking water (4,11,15). Bronchopulmonary infections caused by T. tenax have been reported mainly in patients with underlying cancers or other lung diseases (4,6,9,11,13,(15)(16)(17). The organism is believed to enter the respiratory tract by aspiration from the oropharynx.…”

mentioning

confidence: 99%

Molecular Characterization of Trichomonas tenax Causing Pulmonary Infection

Mallat¹,

Podglajen²,

Lavarde³

et al. 2004

J Clin Microbiol

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A 58-year-old man presented with retrosternal pain 30 months after a surgical operation for reflux esophagitis in relation to Barrett's esophagus. Gastroscopy revealed an ulcer of the inferior part of the esophagus, which on biopsy proved to be an adenocarcinoma. Additional surgery was performed through the abdomen and through the thorax via the sixth intercostal space. Resection of the lower part of the esophagus and high anastomosis were performed because of nondilatable peptic stenosis. Two chest tubes were put in place: one draining the right pleura and the other in contact with the anastomosis. On the second postoperative day, a sepsis-like syndrome including bronchospasm developed with increasing ventilation requirements. A chest radiograph revealed no abnormalities, and a perfusion computed tomography (CT) scan did not show pulmonary thromboembolism. Amoxicillin-clavulanic acid and gentamicin were given for 8 days despite various bacteriological analyses that were all sterile, including 10 blood samples, 3 pleural fluid samples, 1 bronchoalveolar lavage, 1 bronchial aspiration, and 1 urine sample. The patient improved partially, and the pleural tube was removed. On the 13th postoperative day, the patient was still ventilator dependent. Fever recurred, and biological investigations showed a leukocyte count of 11,700/mm 3 and a C-reactive protein level of 128 mg/liter. A chest CT scan revealed a small collection of 1 cm in diameter in contact with the posterior part of the anastomosis and a new infiltrate of the left lung parenchyma located in the apical segment of the lower lobe. Analysis of the fluids from both bronchoalveolar lavage and chest tube showed a large number of neutrophils and numerous flagellated, motile organisms with the typical appearance of trichomonads, visible on wet preparations and Giemsa staining. Culture of bronchoalveolar fluid yielded Neisseria lactamica, while culture of tube fluid yielded alpha-and beta-hemolytic streptococci and Haemophilus parainfluenzae. Treatment with metronidazole, piperacillintazobactam, and gentamicin was started. Trichomonads were not found in the drained fluid, and a chest CT scan showed the resolution of the collection and no change in pulmonary parenchyma 3 and 5 days after the initiation of metronidazole therapy, respectively. The CT scan failed to show passage of contrast material from the esophageal suture line into the mediastinum. Antibiotics, including metronidazole, were continued for 10 days, and the tube was removed later. However, the patient had remained ventilator dependent since the operation. Ischemic brain damage of unknown origin was revealed by cerebral magnetic resonance imaging, and the patient remained in a deep coma for 1 week and then died.In order to identify the species of Trichomonas, we amplified directly from the bronchoalveolar fluid and sequenced the 5.8S rRNA gene and the internal transcribed spacer flanking regions (ITS1 and ITS2) with the forward and reverse primers TRICHO-F and TRICHO-R (5Ј-CGGTAGGTGAACCTGC CGTT-3Ј and...

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mentioning

confidence: 99%

Molecular Characterization of Trichomonas tenax Causing Pulmonary Infection

Mallat¹,

Podglajen²,

Lavarde³

et al. 2004

J Clin Microbiol

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“…It has been proposed that trichomonad parasites probably enter the respiratory tract by aspiration from the oropharynx. In addition, the parasite is known to feed on the aspirated bacteria and therefore it does not cause pulmonary disease by itself (3,16). In case 2, we confirmed the simultaneous presence of T. tenax and a new Tetratrichomonas species in the mouth of the patient and only the presence of the latter in the empyema fluid.…”

Section: Case Reportsmentioning

confidence: 51%

New Tetratrichomonas Species in Two Patients with Pleural Empyema

et al. 2013

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Two unusual occurrences of pleural trichomonosis due to a new Tetratrichomonas species previously reported but not named were confirmed. In one patient, Trichomonas tenax and a Tetratrichomonas species were also detected in the oral cavity by molecular methods. We suggest that this new Tetratrichomonas species be named Tetratrichomonas empyemagena. CASE REPORTSC ase 1 is that of a 54-year-old male from Mexico City with uncontrolled type 2 diabetes who was admitted to the hospital with a history of 1 week of malaise, poor food intake, chills, and fever after developing right thoracic pain, dyspnea, and fatigue; he denied any history of choking or trauma in recent days. Dullness on percussion and decreased breathing sounds were noted over his right chest. His blood pressure was 120/50 mmHg, his heart rate was 120 beats/min, his respiratory rate was 30 breaths/min, his white blood cell count was 45,000/mm 3 , his platelet count was 565,000/mm 3 , his glucose level was 503 mg/dl, his albumin level was 1.6 g/dl, and his arterial HCO 3 level was 5.6 meq/liter. An initial chest X-ray and computed tomography (CT) scan showed a right pleural effusion that was drained (700 ml), and the pleural fluid was sent for microbiological analysis. Its macroscopic appearance was that of a brownish purulent fluid. Microscopic examination revealed Gram-positive cocci and Gram-negative bacilli, as well as numerous motile and flagellated protozoa that were initially identified as trichomonads because of their morphological characteristics (form, size, and motility). These flagellates were not cultured, and their identification was confirmed by microscopic examination of an empyema fluid smear. Samples were mixed with whole blood at 1:3, spread onto glass slides, air dried, methanol fixed, and stained with Giemsa stain (Fig. 1A and B). Some aliquots of empyema fluid were stored at Ϫ20°C for molecular analysis. Bacteriological cultures of the fluid were performed for aerobic and anaerobic microorganisms, yielding Staphylococcus auricularis, but no bacilli were identified until after PCR sequencing of an empyema fluid sample. A Prevotella species was demonstrated by using universal primers for the 16S rRNA gene (1). Antibiotic therapy with metronidazole and piperacillin-tazobactam was administered.Case 2 is that of a 33-year-old man from Mexico City with a history of smoking and alcohol consumption who was admitted to the hospital with a 2-week nonproductive cough and chills, dyspnea, and left pleural chest pain. His blood pressure was 70/40 mmHg, his heart rate was 150 beats/min, and his respiratory rate was 40 breaths/min. During subsequent days, fever and diaphoresis were added to the clinical course, as well as worsening of dyspnea until he developed acute respiratory failure and septic shock. Thorax auscultation revealed bilateral crackles and diminished breath sounds on the left side; he was placed on mechanical ventilation. A chest X-ray and a thorax CT scan showed a right pneumothorax and left pleural effusion. He underwent bilater...

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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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