Clinical feature analysis of pneumonia caused by Tropheryma Whipplei

Abstract Background: Whipple's Disease (WD) is a rare infection caused by Tropheryma whipplei (TW), which affects multiple organs. When the infection invades the respiratory system, severe respiratory failure can be induced. However, due to extremely low prevalence and insufficient awareness, the disease is easily ignored by practitioners. Recently, we found a case of severe pneumonia with TW infection with respiratory failure induced. We combined published cases to perform a retrospective analysis of the clinical features of pneumonia caused by TW, intending to provide a reference for the treatment of WD.Methods: 11 cases of pulmonary TW infection were retrieved from the literature (1992-2022). Together with the single case identified in our hospital, 12 cases were retrospectively analyzed for risk factors, clinical manifestations, diagnosis and treatment, and outcomes.Results: Pulmonary TW infection was more prevalent in middle-aged men without underlying diseases (9/12, 75%). It usually manifested as respiratory symptoms such as cough (6/12, 50%), dyspnoea (7/12, 58.33%), and chest pain (2/12, 16.67%), which can be accompanied by or only manifested as digestive system symptoms, joint pain, fever, and other extrapulmonary symptoms. Pulmonary imaging findings were nonspecific, presenting various alterations, including multiple ground-glass opacities, consolidations, nodules, cavities in both lungs, as well as pleural effusion, interstitial pneumonia, and acute fibrinous and organizing pneumonia. Based on traditional clinical experience, Pulmonary TW infection can be treated by standardized anti-infective therapies.Conclusions: The clinical manifestations and pulmonary imaging findings of Pulmonary TW infection were diverse and non-specific. Hence, it can be easily missed or misdiagnosed. Significant efficacy can be achieved with prompt diagnosis and effective medication, thus more attention should be paid to this disease. To our knowledge, this is the first retrospective study concerning the clinical features of Pulmonary TW infection to date. Nevertheless, the number of cases presented here was small, which requires the supplementation of more clinical data in the future.