Tropheryma whipplei in patients with pneumonia.
Bottom Line: We detected DNA of T. whipplei in 6 (3%) of 210 BAL samples collected in intensive care units by using 16S rDNA and specific quantitative PCR.We identified 4 novel genotypes of T. whipplei.In 1 case, T. whipplei was the only bacterium; in 4 others, it was associated with buccal flora.
Affiliation: CNRS-IRD Faculte de Medecine, Marseille, France.
Tropheryma whipplei is the etiologic pathogenic agent of Whipple disease (WD), characterized by various clinical signs, such as diarrhea, weight loss, lymphadenopathy, and polyarthritis. PCR-based methods for diagnosis of WD have been developed. T. whipplei has been identified in saliva and stool samples from patients with WD and from healthy persons. T. whipplei DNA has also been found in bronchoalveolar lavage (BAL) samples of a child with pneumonia. We detected DNA of T. whipplei in 6 (3%) of 210 BAL samples collected in intensive care units by using 16S rDNA and specific quantitative PCR. We identified 4 novel genotypes of T. whipplei. In 1 case, T. whipplei was the only bacterium; in 4 others, it was associated with buccal flora. We suggest that T. whipplei should be investigated as an etiologic agent of pneumonia.
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Mentions: Bacterial DNA of T. whipplei was detected in 6 of 210 BAL fluid samples by standard or quantitative PCR (Table 1). The patients’ ages ranged from 39 to 73 years (mean ± SD 56.83 ± 14.01 years), and all were men (Table 2). One of those 6 specimens (no. 5) was positive for the bacterium in both standard and quantitative PCR assays. For this patient, PCR with broad-range primers showed that T. whipplei was the only bacterium identified. Moreover, both quantitative PCR assays showed a high level of the bacterium in this specimen (cycle threshold = 20 with Whi3 probe and cycle threshold = 21 with Whi2 probe; 5.105 copy [Table 1]). This patient was immunocompromised and had community-acquired pneumonia and septic shock (Table 2). He was admitted to the medical ICU for septic shock and acute respiratory distress syndrome complicating community-acquired pneumonia (Figure). He received chemotherapy for difficult-to-treat mediastinal lymphoma. A lobectomy on his upper right lung had been done 1 year before admission for the lymphoma. Lung infiltrates were present when he was admitted to the hospital. The patient was febrile (39.2°C) and hypoxemic (partial pressure of oxygen in arterial blood [PaO2] 120 mm Hg for a fraction of inspired oxygen [FiO2] at 1), and pancytopenia was evident after initial examination. He received blood products during his ICU stay (9 packed erythrocytes, 4 fresh frozen plasma, 3 platelet transfusions). He was empirically treated by using ticarcillin/clavulanic acid and erythromycin. Hemodynamic status improved rapidly, and administration of vasopressors was stopped by day 2. The patient was finally extubated at day 7 and discharged from the ICU on day 10. He fully recovered after completing a treatment regimen of imipenem, amikacin, and vancomycin.