Pyopneumothorax Caused by Trichomonas tenax and Porphyromonas endodontalis Coinfection in a Patient with Previous Cerebral Infarction: A Case Report and Literature Review

Abstract

Background

Even with the advent of NGS and PCR diagnostic tools, cases of chest infections caused by Trichomonas are still very rare. Such pathogens are less likely to be considered by clinicians. These cases frequently involve the pleura and lead to pneumothorax, hydropneumothorax, or pyopneumothorax, making the disease severe.

Case Presentation

A 69-year-old man diagnosed with cerebral infarction a year ago sought medical attention for right-sided pyopneumothorax and respiratory failure. The pathogen found in the pleural fluid was highly suspected to be Trichomonas tenax (T. tenax). Pleural fluid mNGS confirmed T. tenax and Porphyromonas endodontalis coinfection. Metronidazole combined with piperacillin tazobactam was administered to counteract infection. Simultaneously, closed chest drainage and thoracoscopic release of pleural adhesions were performed. The patient was cured, discharged from the hospital, and was in good condition after six months of follow-up.

Conclusion

When chest infections occur in patients with poor oral hygiene and underlying diseases that may lead to aspiration, the identification of Trichomonas infection should be noted. Early confirmation of the diagnosis often requires mNGS and PCR. Metronidazole is essentially effective against Trichomonas, and medical thoracoscopy can be used to manage pleural conditions if necessary.

Keywords:

• pyopneumothorax
• Trichomonas tenax
• Porphyromonas endodontalis
• aspiration
• VATS

Abbreviations

T. tenax, Trichomonas tenax; NGS, next-generation sequencing; PCR, polymerase chain reaction; CT, computed tomography; GM, galactomannan; BDG, 1-3-β-D-glucan; TB, tuberculosis; ANA, anti-nuclear antibody; BALF, bronchoalveolar lavage fluid; VATS, video-assisted thoracic surgery.

Data Sharing Statement

The data are available from the corresponding author on reasonable request.

Consent for Publication

Written informed consent was obtained from the patient and his family for the publication of this manuscript. Institutional approval is not required to release case details.

Acknowledgment

The authors are grateful to Dr Yun-wei Zheng for providing photos of the microorganism.

Disclosure

The authors declare no conflicts of interest in relation to this work.

Additional information

Funding

There is no funding to report.