Background In addition to the well-known Whipple’s disease (WD), Tropheryma Whipplei (TW) can also lead to acute pneumonia. There is no unified consensus on the susceptible population, pathogenesis, clinical manifestations, diagnostic criteria, and treatment options for TW pneumonia. Clinical Presentation and Intervention This is an elderly patient with multiple injuries caused by falling from a building, and was transferred to intensive care unit (ICU) for mechanical ventilation and empirical anti-infection treatment due to severe pneumonia, and then the results of targeted next-generation sequencing (tNGS) in patient’s bronchoalveolar lavage fluid (BALF) suggested TW and human metapneumovirus (HMPV) infection, and after switching to anti-infective therapy for TW, the patient was successfully extubated and transferred out of the ICU. Conclusion This is the first case of using tNGS to diagnose severe pneumonia caused by TW and HMPV. We hope that our study can serve as a reference for the diagnosis and treatment of related cases in the future.

Using Targeted Next-Generation Sequencing to Diagnose Severe Pneumonia Due to Tropheryma Whipplei and Human Metapneumovirus: A Case Report and Literature Review

<h2>Abstract</h2> Tropheryma whipplei (TW) is a rod-shaped, gram-positive bacterium that, when chronically infects humans, can lead to multi-system pathologies, including joint pain, abdominal pain with diarrhea and weight loss, myocarditis, pericarditis, and neurologic inflammation. Moreover, acute infections can lead to bronchopulmonary infections, bacteraemia, and acute diarrhea. However, fewer cases of acute pneumonia due to TW have been reported, and this diagnosis is not well founded. Herein, we report a case of acute pneumonia caused by a TW infection. The patient, a middle-aged man, underwent bronchoscopic alveolar lavage, and the metagenomic next-generation sequencing of the lavage fluid suggested TW infection. A lung puncture biopsy tissue specimen was also positive based on periodic acid-Schiff staining. After confirming the diagnosis, the patient was administered ceftriaxone for anti-infection treatment, improving clinical symptoms and lung imaging results. Therefore, in cases where conventional anti-infective treatment is ineffective for patients with acute pneumonia, we should consider the possibility of TW infection, conduct prompt pathogenetic examination, and provide timely treatment after diagnosis to improve overall patient prognosis.

Acute pneumonia due to Tropheryma whipplei diagnosed by metagenomic next-generation sequencing and pathology: A case report

Whipple's disease (WD) is a multiple‑system chronic disease caused by Tropheryma whipplei (T. whipplei) infection. The present study describes 3 cases of WD with clinical manifestations of cough, chest pain, headache, dyspnea, sputum, joint pain, abdominal pain, diarrhea and weight loss. Chest computed tomography (CT) showed signs of plaques, nodules and pleural thickening; and bronchoscopic alveolar lavage fluid metagenomic‑sequencing indicated that it was T. whipplei. One patient was treated with meropenem as the starting regimen and two patients were treated with ceftriaxone as the starting regimen. Furthermore, two patients were provided with a maintenance regimen of cotrimoxazole and one was given a maintenance regimen of minocycline, which was combined with meropenem and ceftriaxone in order to improve their cough, chest pain, headache and dyspnea symptoms. To the best of our knowledge, there are few reports on WD of the respiratory system caused by T. whipplei, and differential diagnosis is the key to clinical diagnosis. When WD of the respiratory system is difficult to diagnose, metagenomic second‑generation sequencing (mNGS) may be a better choice, which can achieve early diagnosis and early treatment. However, its clinical value is still limited; therefore, more research needs to be conducted in the future.

Whipple's disease of the respiratory system: A case report

Abstract Background Whipple's disease is a rare infectious disease with multi system damage caused by Tropheryma whipplei infection. Classic Whipple's disease often is presents with polyarthritis, digestive system symptoms, and weight loss. The atypical symptoms caused by Tropheryma whipplei infection, harsh in vitro culture conditions, and easily is to be complicated with other pathogenic bacteria infection, which have brought great difficulties and challenges to clinical diagnosis. Herpes simplex virus type 1 infection is common in immunocompromised patients or ventilator-associated pneumonia, but herpes simplex virus type 1 pneumonia is very rare in immunocompetent patients. Without timely diagnosis and treatment, the impact on patients is usually fatal. Case presentation The patient reported in this paper is an 87-year-old female with normal immune function, who suffered from severe pneumonia caused by Tropheryma whipplei and herpes simplex virus type 1 infection. After the diagnosis was confirmed by metagenomic next-generation sequencing, we started treatment with TMP-SMX and acyclovir, and her symptoms improved rapidly and she was successfully discharged from the hospital. Conclusions As far as we know, pneumonia caused by Tropheryma whipplei and herpes simplex virus type 1 is very rare, and early diagnosis and treatment are crucial, because it can improve the prognosis of patients. 

Severe pneumonia caused by Tropheryma whipplei combined with herpes simplex virus type 1 infection in an elderly: a case report of immunocompetent patient

Abstract Background: In addition to the well-known Whipple’s disease (WD)，infection with Tropheryma whipplei(TW) can also lead to acute pneumonia, but due to the lack of specific clinical manifestations and diagnostic measures, diagnosing TW-related pneumonia is extremely difficult. Clinical Presentation and Intervention: This is an elderly patient with multiple injuries caused by falling from a building, and was transferred to intensive care unit (ICU)for mechanical ventilation and empirical anti-infection treatment due to severe hospital-acquired pneumonia(HAP), and then the patient's bronchoalveolar lavage fluid (BALF) targeted next-generation sequencing (tNGS) suggested TW and human metapneumovirus(HMPV) infection, and after switching to anti-infective therapy for TW, the patient was successfully extubated and transferred out of the ICU. Conclusion: This is the first case that using tNGS to diagnose severe pneumonia caused by TW and HMPV. We hope that our study can serve as a reference for the diagnosis and treatment of related cases in the future. 

Using targeted next-generation sequencing to diagnose severe pneumonia due to Tropheryma Whipplei and Human Metapneumovirus:a case report and literature review

http://www.cell.com/article/S2405844023043402/pdf

Experience in the diagnosis and treatment of pneumonia caused by infection with Tropheryma whipplei: A case series

The Diagnosis and Treatment Experience Sharing of Tropheryma Whipplei's Pneumonia: A Case Series

Corrigendum to “Experience in the diagnosis and treatment of pneumonia caused by infection with Tropheryma whipplei: A case series” [Heliyon Volume 9, Issue 6, June 2023, Article e17132]

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Experience in the diagnosis and treatment of pneumonia caused by infection with Tropheryma whipplei: A case series

The Diagnosis and Treatment Experience Sharing of Tropheryma Whipplei's Pneumonia: A Case Series

Corrigendum to “Experience in the diagnosis and treatment of pneumonia caused by infection with Tropheryma whipplei: A case series” [Heliyon Volume 9, Issue 6, June 2023, Article e17132]