Analysis of clinical features of Trophery whipplei pneumonia in children
LI Changchang, PAN Xiaoyu,REN Xikai, JIA Xiaohui, SU Miaoshang.
Department of Pediatric Respiratory Medicine, the Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China
Abstract：Objective: To investigate the clinical features, diagnosis and treatment of Trophery whipplei (TW) pneumonia in children and to improve the understanding of the disease. Methods: The clinical data of 3 children with TW pneumonia admitted to the Department of Pediatric Respiratory of the Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University from August 2020 to January 2022 were analyzed retrospectively. The keywords “Trophery whipplei” and “lung infection” or “pneumonia” were used in China Knowledge Network and Wanfang database, and the keywords “Trophery whipplei” and “pneumonia” were used as keywords to search the relevant literature in PubMed database since the establishment of the database until July 2022. The clinical features, ancillary examinations, treatment and prognosis of TW pneumonia were summarized. Results: Of the three children in this paper, two were male and one was female, with a mean age of (7.3±2.3)years. TW was detected by macrogenomic second generation sequencing (BALF mNGS) of alveolar lavage fluid in all cases, and Haemophilus influenzae was detected in case 3 combined. All 3 cases were treated with ceftriaxone injection anti-infection, combined or renewed with TMP-SMZ, and the prognosis was good in the remaining 2 cases except case 2, which had a poor prognosis. Three Chinese literature articles and 15 English literature articles were searched for eligible cases, totaling 23 cases. Together with the 3 cases in our group, a total of 26 cases, the clinical features of the disease were non-specific, mainly presenting as cough (14 cases), dyspnea/shortness of breath (12 cases), and chest pain (6 cases). Conclusion: Whipple’s feeder pneumonia is mostly a chronic lung infection with atypical clinical features and imaging manifestations, which is very easy to be misdiagnosed clinically. Early BALF mNGS can help to clarify the pathogen and assist in the diagnosis, and reasonable anti-infective treatment can rapidly relieve the symptoms, but it is easy to recur, and the prognosis is mostly good.
