Pneumocystis pneumonia: immunosuppression, Pneumocystis jirovecii...and the third man

Duboucher, Christophe; Boggia, Rosa; Morel, Gérard; Capron, Moníque; Pierce, Raymond J.; Dei‐Cas, Eduardo; Viscogliosi, Éric

doi:10.1038/nrmicro1621-c1

Cited by 5 publications

(6 citation statements)

References 12 publications

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“…The question of whether trichomonads actually occur in the respiratory tracts of patients with underlying pulmonary pathologies is raised, and the frequency of this occurrence is probably broadly underestimated for three main reasons. First, most trichomonad cells detected in different clinical contexts undergo deep morphological modifications that involve a change from a flagellate to an amoeboid form (4,5,7,8). Such change renders the identification of these parasites extremely difficult for observers not aware of the pleomorphism of these parasites.…”

Section: Case Reportmentioning

confidence: 99%

“…Therefore, the significance of the pulmonary location of these parasites has to be clarified. Several observations suggest the potentially pathogenic effect of trichomonads on the alveolar epithelia of patients (7). However, physiopathological studies of these parasites have to be performed by developing in situ hybridization methods for lung tissues of patients and/or animal models of pulmonary coinfection by trichomonads and other microorganisms in order to confirm this hypothesis.…”

Section: Case Reportmentioning

confidence: 99%

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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: 99%

Section: Case Reportmentioning

confidence: 99%

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

et al. 2009

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“…Some readers even expressed doubt. 7 Nevertheless, this observation was also made earlier and was published in 2001. 8 The authors described "unidentified cells" almost exclusively in the BALF of patients infected with HIV.…”

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confidence: 59%

SARS-CoV-2 and superimposed infection by trichomonads

Duboucher

2021

Journal of Infection

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“…While both pathogens can independently affect the respiratory system, their potential interaction within the lung environment has attracted attention in clinical settings. Research has indicated that trichomonads are frequently found in the course of human Pneumocystis jiroveci pneumonia ( Duboucher et al., 2007b ). The hypothesis is that local alveolar conditions, rather than immunodepression, are the main factors favoring the development of trichomonads ( Duboucher et al., 2008 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical implications of trichomonads detected in bronchoalveolar fluid by metagenomic next-generation sequencing: a multicenter retrospective study

Jiang,

Li,

Wang

et al. 2024

Front. Cell. Infect. Microbiol.

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BackgroundPulmonary trichomoniasis is considered a neglected disease due to failures in recognizing it, stemming from insensitive microbial methods and a lack of specific clinical features. This study aims to analyze the clinical implications of trichomonads detected in bronchoalveolar lavage fluid (BALF) by metagenomic next-generation sequencing (mNGS).MethodsThis multicenter retrospective study included patients diagnosed with pneumonia, admitted to three tertiary hospitals in China from July 2018 to September 2022, with trichomonads detected in BALF through mNGS. The analysis covered demographics, comorbidities, symptoms, laboratory findings, mNGS results, clinical treatment, and outcomes of these patients.ResultsA total of 17 patients were enrolled, comprising 14 males and 3 females. Trichomonas tenax and Trichomonas vaginalis were detected by mNGS in BALF samples of 15 and 2 patients, respectively. Patients were categorized into two groups based on the presence of risk factors for trichomonad infection, including immunocompromised conditions, uncontrolled diabetes mellitus, oral/periodontal diseases, and aspiration. Among 11 patients with risk factors (Case 1-11), 4 received nitromidazoles as part of comprehensive treatment, achieving a 100% treatment success rate. The remaining 7 patients, who did not receive nitromidazoles, had only one achieving relief after broad-spectrum antimicrobial therapy, resulting in a 14.3% treatment success rate. For the 6 patients without any risk factors for trichomonad infection (Case 12-17), none received nitromidazoles during hospitalization. However, 4 out of these 6 patients (66.7%) eventually recovered.ConclusionmNGS proves to be an efficient tool for detecting trichomonads in BALF samples. Comprehensive analysis of clinical features and laboratory indicators is essential to distinguish between infection and colonization of trichomonads. Pulmonary trichomoniasis should not be overlooked when trichomonads are detected in BALF from patients with risk factors.

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Pneumocystis pneumonia: immunosuppression, Pneumocystis jirovecii...and the third man

Cited by 5 publications

References 12 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

SARS-CoV-2 and superimposed infection by trichomonads

Clinical implications of trichomonads detected in bronchoalveolar fluid by metagenomic next-generation sequencing: a multicenter retrospective study

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