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

Abstract

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...

Co-infection by Tritrichomonas foetus and Pentatrichomonas hominis in asymptomatic cats

“…Not only between animals, but also for humans. Several reports in the literature suggest respiratory and intestinal infections in humans by these two etiologic agents (Jongwutiwes et al 2000, Kutisova et al 2005, Duboucher et al 2006, Mantini et al 2009). Considering these findings, these species should be carefully monitored as a question of public health in humans and domestic animals, related potential from the viewpoint of zoonotic transmission and poorly studying pathogenicity.…”

Empyema Caused by Prevotella bivia Complicating an Unusual Case of Spontaneous Chylothorax

“…A 50-ml sample of purulent fluid was characterized by a pH of 6.8, a lactate dehydrogenase (LDH) level of 1,320 IU/liter, a WBC count of 10,840 cells/l (96% neutrophils), high triglyceride levels (270 mg/dl versus serum level of 67 mg/dl), a low cholesterol level (10 mg/dl), and no identifiable cholesterol crystals. Microscopic examination of the fluid showed numerous neutrophils but no parasites or ova (1)(2)(3)(4). Gram staining revealed short rod-shaped bacteria, and cytology was negative for malignancy.…”

New Tetratrichomonas Species in Two Patients with Pleural Empyema

“…The phylogenetic inference (Fig. 2) showed that both of the trichomonads found in the lungs of our patients were grouped in a separate clade with high levels of statistical support (a posterior probability of 0.96) with sequences of the new Tetratrichomonas species previously reported by Mantini et al (4). They were 99% identical, and they were distant from Tetratrichomonas gallinarum and other species of the Tetratrichomonas genus.…”