Tropheryma whipplei pneumonia: a retrospective case series of nine patients with treatment response
Abstract
Background The detection of Tropheryma whipplei in respiratory specimens has increased with metagenomic next-generation sequencing (mNGS), yet distinguishing colonization from active infection remains challenging. In clinical settings lacking quantitative PCR or pathological confirmation, practical approaches to guide treatment decisions are urgently needed. Methods We retrospectively analyzed nine patients (January 2019–January 2024) with T. whipplei detected by bronchoalveolar lavage fluid (BALF) mNGS. All patients initially received cefoperazone-sulbactam (3.0 g q8h) as empirical therapy for 3–5 days without improvement. Targeted therapy (ceftriaxone or meropenem combined with doxycycline or trimethoprim-sulfamethoxazole) was subsequently initiated. We describe clinical characteristics and treatment outcomes. Results Among nine patients (3 male, 6 female; mean age 59 years, range 32–79), six (67%) were immunosuppressed. Primary manifestations included fever (67%), cough with sputum (89%), and dyspnea (78%). Common laboratory findings were anemia (67%), lymphocytopenia (67%), hypoalbuminemia (100%), and elevated inflammatory markers (78%). Chest CT predominantly showed patchy ground-glass opacities. Eight cases (89%) had co-infections. All patients showed no improvement after initial cefoperazone-sulbactam therapy. After targeted therapy was initiated, eight patients (89%) achieved defervescence within 3–5 days, with resolution of pulmonary infiltrates on follow-up CT…
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Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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