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

Figures & data

Figure 1 Chest CT on admission showing right pleural effusion, and pneumothorax.

Figure 2 Against a background of necrotic fragments, a pear-shaped body with flagella was visible, containing a large dark purple long oval nucleus shaped like a mouse eye, highly suspicious for T. tenax. (indicated by arrow, Richter-Giemsa stain, ×1000).

Figure 3 Chest CT at discharge showing that the right pleural effusion and pneumothorax were markedly absorbed.

Table 1 Clinical Characteristics of the 15 Cases of Chest Infections Caused by Trichomonas

Publishing Year	Age/Sex	Region	Pleural Disease	Trichomonas Species	Underlying Disease	Coinfection Pathogen	Medication	Other Treatment Measures	Outcome
2021	16/M	China	Bilateral pneumonia and a right large amount of pyopneumothorax	Trichomonas tenax	Cerebral palsy	Geotrichum capitatum	Metronidazole and voriconazole	Surgical cleaning of the pleural cavity and video-assisted thoracoscopic decortication	Improved
2019	81/F	China	Bilateral pneumonia and left pyopneumothorax, right pleural effusion	Tetratrichomonas	Cerebral infarction; type 2 diabetes	Streptococcus anginosus	Tienam and metronidazole	-	Improved
2014	66/F	Japan	-	-	-	-	-	-	-
2013	33/M	Mexico	A right pneumothorax and left pleural effusion	Tetratrichomonas empyemagena	No description	Gram-positive cocci and bacilli, and Gram-negative rods	Metronidazole and piperacillin–tazobactam	-	No description
2013	54/M	Mexico	A right pleural effusion	Tetratrichomonas empyemagena	Type II diabetes	Gram-positive cocci and Gram-negative bacilli	Metronidazole and piperacillin–tazobactam	-	No description
2012	67/M	France	A right hydropneumothorax	Trichomonas tenax	Glioblastoma, high-dose corticotherapy	Aero-anaerobic flora	Metronidazole, amoxicillin	-	Death
2009	40/F	France	A right pleural effusion	Tetratrichomonas	No description	Streptococcus constellatus and Streptococcus gordonii; anaerobic bacterium	Metronidazole	-	Improved
2008	33/F	France	A right hydropneumothorax	Trichomonas tenax	Cardiac transplantation	Prevotella oralis, Peptostreptococcus sp., and Streptococcus sp.	Piperacillin–tazobactam and metronidazole	A surgical cleaning of the pleural cavity	Improved
2008	3 months/F	France	No description	Trichomonas vaginalis	None	No description	Metronidazole	None	Improved
2006	55/m	China	Bilateral pleural effusion leading to respiratory failure	Trichomonas species	None	Nutritionally variant Streptococcus.	Metronidazole, ampicillin/clavunalate	Thoracotomy decortication	Improved
2005	84/M	France	Bilateral pneumonia and pleural disorders	Trichomonas tenax	Chronic lymphoid leukemia with hypogammaglobulinemia	No description	Metronidazole	-	Improved
2004	58/M	France	Left pneumonia and pleural disorders	Trichomonas tenax	A surgical operation for reflux esophagitis	Streptococci and Haemophilus parainfluenzae	Metronidazole, piperacillin, tazobactam, and gentamicin	-	Death
2003	56/M	USA	Bilateral pneumonia and loculated right pleural effusion	Trichomonas tenax	A duodenal feeding tube was inadvertently placed into the right lung after brain surgery; type II diabetes mellitus	Streptococcus constellatus	Metronidazole; piperacillin/tazobactam and tobramycin	-	Improved
2002	59/M	France	Right pyopneumothorax	Trichomonas tenax	Metastatic adenocarcinoma of the lung following treatment with corticosteroids and radiotherapy	Bacteria	Metronidazole, ciprofloxacin and gentalline	-	Death
Our case	69/M	China	Right pyopneumothorax	Trichomonas tenax	Cerebral infarction	Aero-anaerobic flora	Metronidazole → Levonidazole; piperacillin/tazobactam	Thoracoscopic release of pleural adhesions	Improved