PDF(Pubmed)
Abstract：
Adult respiratory distress syndrome due to viral pneumonia occurs predominantly in immunodeficient populations; adult respiratory distress syndrome secondary to human herpesvirus HHV-6 and HHV-7 pneumonia is extremely rare. Whipple\'s disease, caused by Tropheryma whipplei, a Gram-positive bacillus and obligate intracellular pathogen, is clinically challenging to diagnose. Whipple\'s disease is a chronic multisystem infectious disease caused by T. whipplei, most often affecting the gastrointestinal tract and joints, seldom the lungs. Both pathogens are opportunistic. We report a case of mixed infectious pneumonia in a patient with type 2 diabetes mellitus. The patient presented with dyspnea and intermittent fever. Imaging revealed multiple large patchy consolidations in the left lung. Routine anti-infective therapy was ineffective. Metagenomic next generation sequencing of bronchoalveolar lavage fluid indicated HHV-6 and HHV-7 pneumonia concurrent with T. whipplei and Streptococcus co-infections. Meropenem was administered to improve treatment. This case represents a rare mixed lung infection by multiple uncommon pathogens, and is of particular clinical significance.
摘要：
病毒性肺炎引起的成人呼吸窘迫综合征主要发生在免疫缺陷人群中；继发于人类疱疹病毒HHV-6和HHV-7肺炎的成人呼吸窘迫综合征极为罕见。Whipple病,由Tropherymawhipplei引起，革兰氏阳性杆菌和专性细胞内病原体，临床诊断具有挑战性。Whipple病是由WhippleiT.引起的慢性多系统传染病，最常影响胃肠道和关节，很少有肺。两种病原体都是机会主义的。我们报告了一例2型糖尿病患者的混合感染性肺炎。患者出现呼吸困难和间歇性发热。影像学显示左肺有多个大的斑片状巩固。常规抗感染治疗无效。支气管肺泡灌洗液的宏基因组下一代测序表明，HHV-6和HHV-7肺炎同时伴有T.whipplei和链球菌共感染。给予美罗培南以改善治疗。此病例代表由多种罕见病原体引起的罕见混合肺部感染，具有特殊的临床意义。
