Novel Tropheryma species in a lung biopsy sample from a kidney transplant recipient

Vankeerberghen, Anne; Jonckheere, Stijn; Raeve, Hilde De; Caluwé, Rogier; Beenhouwer, H. De

doi:10.1016/j.cmi.2017.09.011

Cited by 9 publications

(4 citation statements)

References 14 publications

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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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Section: Discussionmentioning

confidence: 99%

Pulmonary parenchymal involvement caused by Tropheryma whipplei

Zhang

2021

Open Medicine

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“…The main clinical symptoms of these 16 patients in our study include fever, cough, dyspnea and Expectoration, but neurological symptoms and arthralgia and were rare. According to the currently reported cases of acute or chronic respiratory tract infections caused by T.whipplei, the main manifestation of all patients is respiratory symptoms, and very few patients may also develop gastrointestinal or other typical features of Whipple's disease [34] . It remains di cult to gauge the role of the T. whipplei pathogenesis in pneumonia.…”

Section: Discussionmentioning

confidence: 99%

Tropheryma whipplei detection by metagenomic next-generation sequencing in bronchoalveolar lavage fluid

lai,

zhu,

zhao

et al. 2023

Preprint

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Background: Whipple's disease is a chronic systemic infectious disease that mainly affects the gastrointestinal tract. Tropheryma whipplei is common in healthy individuals, but in some cases, Tropheryma whipplei can cause infection at the implant site or even throughout the body. The delay between the first clinical symptoms and diagnosis of Whipple's disease and Whipple's trophoblast infection exceeds 6 years, and recurrence is often observed. Therefore, clinical doctors need to understand the characteristics of this infection. Methods: We collected blood, sputum, and alveolar lavage fluid samples from all patients with Tropheryma whipplei from 2020 to 2022, and retrospectively analyzed the clinical data of Sample with Tropheryma whipplei. Patient's past history, clinical manifestations, laboratory examinations, chest CT findings, treatment, and prognosis were recorded. Results: 16 BALFs (70/1725, 4.0%) from 16 patients were positive for Tropheryma whipplei. 8 patients were male with an average age of 50 years. The main clinical symptoms of patients included fever (9/16), cough (7/16), dyspnea(7/16), and Expectoration(5/16), but neurological symptoms and arthralgia and were rare. Cardiovascular and cerebrovascular diseases were the most common comorbidity (n=8).The main laboratory characteristics of the patient are red blood cell count, hemoglobin, total protein and albumin below normal levels(11/16) , and/or creatinine above normal levels(14/16). Most chest computer tomography manifestations include focal or patchy heterogeneous infection (n=5) and pleural effusion (n=8). Among the 6 samples, Tropheryma whipplei was the sole agent, and Klebsiella pneumoniae was the most common detected other pathogens. Conclusions: Metagenomic next-generation sequencing technology has improved the detection rate and attention of Tropheryma whipplei. Further research is needed to distinguish whether Tropheryma whipplei present in respiratory samples is a pathogen or an innocent bystander.

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“…The most common presentation was loose stools and weight loss 1,4,11 ; others presented with endocarditis, 10 chorioretinitis, 9 and pulmonary nodules. 8 The time since transplant was variable between 2 months and 12 years. All patients except one received IV CRO followed by PO TMP/SMX for 6-24 months with resolution of symptoms.…”

Section: Review Of Literaturementioning

confidence: 99%

“…To the best of our knowledge, six cases of WD have been reported in solid organ transplant recipients to date. 1,4,[8][9][10][11] Here, we present a case series of seven renal transplant recipients diagnosed with WD at our center. He tolerated the drugs with weight gain of 6 kg.…”

Section: Introductionmentioning

confidence: 99%

Whipple's disease in renal transplant recipients: Management experience of seven cases from Pakistan

Nasim

Dodani

Badlani

et al. 2021

Transplant Infectious Dis

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Introduction: Whipple's disease (WD) is a rare multi-systemic disorder caused by actinomycetes, Tropheryma whipplei. It presents with weight loss, arthralgia, and diarrhea and may involve the heart, lung, or central nervous system. The use of immunosuppressive medications or underlying immunodeficiency states are associated risk factors. Six cases in transplant recipients have so far been reported worldwide. We describe our experience of WD in renal transplant recipients.Methods: All renal transplant recipients who presented with diarrhea and were diagnosed with WD on duodenal biopsy from 2016 till 2019 were included. Their data regarding duration since transplantation, immunosuppressive therapy, symptoms, treatment response, and outcome were analyzed.Results: Seven cases were diagnosed as WD based on duodenal biopsy, with histological findings of periodic acid Schiff-positive granules in macrophages. All were males. The most common symptoms were chronic diarrhea and weight loss. Average time since transplantation was 4.8 years. All patients were on azathioprine and everolimus. Clinical relapse or adverse effects was seen in five of seven patients treated with doxycycline and hydroxychloroquine which was discontinued. Trimethoprim/sulfamethoxazole for 1 year, with initial intravenous ceftriaxone in two patients, resulted in complete remission in all patients at a follow-up period averaging 1.5 years. Conclusion:WDs in renal transplant recipients most commonly presents as an intestinal disorder. Treatment of 1 year with trimethoprim/sulfamethoxazole has good response with complete remission at 1.5 years of follow up.

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Novel Tropheryma species in a lung biopsy sample from a kidney transplant recipient

Cited by 9 publications

References 14 publications

Pulmonary parenchymal involvement caused by Tropheryma whipplei

Pulmonary parenchymal involvement caused by Tropheryma whipplei

Tropheryma whipplei detection by metagenomic next-generation sequencing in bronchoalveolar lavage fluid

Whipple's disease in renal transplant recipients: Management experience of seven cases from Pakistan

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