Nonischemic Myocardial Changes Detected by Cardiac Magnetic Resonance in Critical Care Patients with Sepsis

bronchoalveolar lavage (BAL) showed 900 leukocytes with 88% neutrophils.PCR-based detection of cytomegalovirus, herpes virus, Aspergillus sp., Mycobacterium tuberculosis, and Pneumocystis jiroveci were negative.Specific PCR, targeting repeated sequences, detected T. whipplei in significant concentrations (8 3 10 4 /ml), as those observed among patients (2, 3).T. whipplei genotyping, all of which corresponds to the concatenation of four spacers, identified a new genotype (5) related to two genotypes that have been previously only identified in Senegal.Amplification and sequencing of 16S rDNA gene (4) performed on the BAL fluid identified mainly Prevotella oralis and Haemophilus influenzae among the 96 clones screened but not T. whipplei.Specific PCR detected 10 6 /ml of H. influenzae.Aero/ anaerobic culture and Ziehl-Neelsen staining were negative.The patient was initially treated with 2 g ceftriaxone per day.Cotrimoxazole was added at Day 5 as there was no clinical improvement.The patient subsequently improved and was discharged 2 weeks later.T. whipplei in vitro is resistant to ceftriaxone, but it is susceptible to sulfamethoxazole, and infections caused by this bacterium may be treated by cotrimoxazole ( 6).The clinical response to cotrimoxazole suggests a role for T. whipplei in the patient's pneumonia.In a Senegalese population, we have reported that T. whipplei is a relatively common cause of bacteremia, fever, and cough (5).The recent work of Lozupone and colleagues revealed surprisingly high rates of lung colonization with T. whipplei in patients with HIV infection (1).This case extends those findings by suggesting that T. whipplei can be a cause of pneumonia in this population.We suggest that T. whipplei be considered in the differential diagnosis of pneumonia in patients with advanced HIV infection.