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Didier Raoult - One of the best experts on this subject based on the ideXlab platform.
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Tropheryma whipplei Increases Expression of Human Leukocyte Antigen-G on Monocytes to Reduce Tumor Necrosis Factor and Promote Bacterial Replication
Gastroenterology, 2018Co-Authors: Eya Ben Azzouz, Jean-louis Mege, Didier Raoult, Asma Boumaza, Soraya Mezouar, Matthieu Bardou, Federico Carlini, Christophe Picard, Benoit DesnuesAbstract:Infection with Tropheryma whipplei has a range of effects-some patients can be chronic carriers without developing any symptoms whereas others can develop systemic Whipple disease, characterized by a lack a protective inflammatory immune response. Alterations in major histocompatibility complex, class I, G (HLA-G) function have been associated with several diseases. We investigated the role of HLA-G during T whipplei infection.
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Mesenteric lymphadenitis as a presenting feature of Whipple’s disease: Value of PCR analysis
Elsevier, 2018Co-Authors: Lucie Wartique, Didier Raoult, Jean Christophe Lagier, Yvan Jamilloux, Pascal SèveAbstract:Whipple’s disease (WD) is a rare chronic and systemic infection caused by the ubiquitous actinomycete Tropheryma whipplei. A case of localized infection with mesenteric adenopathy associated with a prolonged unexplained fever is reported herein. Screening by PCR on saliva and stool was positive, and T. whipplei was formally identified by specific PCR on duodenal and mesenteric adenopathy biopsies. Histological analysis did not demonstrate periodic acid–Schiff-positive macrophages or positive T. whipplei immunochemistry in either the duodenal mucosa or mesenteric nodes. Treatment with hydroxychloroquine and doxycycline allowed a rapid resolution of symptoms, and subsequent saliva and stool PCR results were negative. Keywords: Tropheryma whipplei, Whipple’s disease, Polymerase chain reaction, Mesenteric lymphadeniti
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Whipple's Disease: Diagnostic Value of rpoB Gene PCR from Peripheral Blood Mononuclear Cells.
Molecular Diagnosis and Therapy, 2018Co-Authors: Kathleen Weigt, Alexandra Wiessner, Kristina Allers, Florence Fenollar, Didier Raoult, Annette Moter, Thomas SchneiderAbstract:Introduction Chronic infection with Tropheryma whipplei, known as Whipple’s disease (WD), classically affects the gastrointestinal tract, but any organ system may be affected, and isolated manifestations occur. Reliable diagnosis based on a combination of periodic acid–Schiff (PAS) staining, T. whipplei-specific immunohistochemistry (IHC), and polymerase chain reaction (PCR) from duodenal biopsies may be challenging in cases without classical gastrointestinal infection, so the need for additional diagnostic materials is urgent. Objective Our objective was to evaluate additional diagnostic possibilities for WD. Methods We analyzed samples from 20 patients with WD and 18 control subjects in a prospective observational pilot study. In addition to WD diagnosis by PAS staining, T. whipplei-specific IHC and PCR of duodenal or extra intestinal tissues, whole EDTA blood, peripheral blood mononuclear cells (PBMCs) and PBMC fractions enriched with or depleted of cluster of differentiation (CD)-14+ cells were examined using T. whipplei rpoB gene PCR. Results Tropheryma whipplei DNA was detected in 35 of 60 (58.3%) preparations from 16 of 20 patients with WD, most of whom lacked gastrointestinal signs and characteristic PAS-positive duodenal macrophages. Conclusion This study provides evidence for the potential suitability of blood, particularly PBMCs, as material to assist in the diagnosis of WD via rpoB gene real-time PCR. Thus, PCR from blood preparations can be helpful for diagnostic decision making in atypical cases of WD.
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Whipple's disease and Tropheryma whipplei infections: when to suspect them and how to diagnose and treat them
Current opinion in infectious diseases, 2018Co-Authors: Jean Christophe Lagier, Didier RaoultAbstract:Purpose of reviewThe delay between first clinical signs and diagnosis of Whipple's disease and Tropheryma whipplei infections is more than 6 years, and relapses are frequently observed, resulting in a need for clinicians to be aware of this infection.Recent findings18 FDG-PET is useful in the diagno
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Acute infections caused by Tropheryma whipplei
Future Microbiology, 2017Co-Authors: Jean Christophe Lagier, Florence Fenollar, Didier RaoultAbstract:Tropheryma whipplei is the causative bacterium of Whipple's disease. Its first culture has led to an enlargement of the field of the caused infections. Here, we comprehensively review acute T. whipplei infections. In a cohort study featuring 4000 children, T. whipplei was significantly more common in patients with diarrhea (4%) than in those without (1.7%). A case-controlled study highlighted 58 patients suffering from pneumonia with the detection of T. whipplei in their bronchoalveolar fluids. Finally, a recent study detected T. whipplei in the blood of 36 febrile patients experiencing pulmonary symptoms in a rural area of Senegal. T. whipplei is definitively an agent of acute gastroenteritis, a cause of nonmalarial fever in Africa, and probably a cause of pulmonary infections.
Florence Fenollar - One of the best experts on this subject based on the ideXlab platform.
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Whipple's Disease: Diagnostic Value of rpoB Gene PCR from Peripheral Blood Mononuclear Cells.
Molecular Diagnosis and Therapy, 2018Co-Authors: Kathleen Weigt, Alexandra Wiessner, Kristina Allers, Florence Fenollar, Didier Raoult, Annette Moter, Thomas SchneiderAbstract:Introduction Chronic infection with Tropheryma whipplei, known as Whipple’s disease (WD), classically affects the gastrointestinal tract, but any organ system may be affected, and isolated manifestations occur. Reliable diagnosis based on a combination of periodic acid–Schiff (PAS) staining, T. whipplei-specific immunohistochemistry (IHC), and polymerase chain reaction (PCR) from duodenal biopsies may be challenging in cases without classical gastrointestinal infection, so the need for additional diagnostic materials is urgent. Objective Our objective was to evaluate additional diagnostic possibilities for WD. Methods We analyzed samples from 20 patients with WD and 18 control subjects in a prospective observational pilot study. In addition to WD diagnosis by PAS staining, T. whipplei-specific IHC and PCR of duodenal or extra intestinal tissues, whole EDTA blood, peripheral blood mononuclear cells (PBMCs) and PBMC fractions enriched with or depleted of cluster of differentiation (CD)-14+ cells were examined using T. whipplei rpoB gene PCR. Results Tropheryma whipplei DNA was detected in 35 of 60 (58.3%) preparations from 16 of 20 patients with WD, most of whom lacked gastrointestinal signs and characteristic PAS-positive duodenal macrophages. Conclusion This study provides evidence for the potential suitability of blood, particularly PBMCs, as material to assist in the diagnosis of WD via rpoB gene real-time PCR. Thus, PCR from blood preparations can be helpful for diagnostic decision making in atypical cases of WD.
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IRF4 haploinsufficiency in a family with Whipple's disease
eLife, 2018Co-Authors: Antoine Guerin, Florence Fenollar, Gaspard Kerner, Nico Marr, Janet G. Markle, Natalie Wong, Sabri Boughorbel, Danielle T. Avery, Salim Bougarn, Matthieu BouazizAbstract:Most humans are exposed to Tropheryma whipplei (Tw). Whipple's disease (WD) strikes only a small minority of individuals infected with Tw (
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Acute infections caused by Tropheryma whipplei
Future Microbiology, 2017Co-Authors: Jean Christophe Lagier, Florence Fenollar, Didier RaoultAbstract:Tropheryma whipplei is the causative bacterium of Whipple's disease. Its first culture has led to an enlargement of the field of the caused infections. Here, we comprehensively review acute T. whipplei infections. In a cohort study featuring 4000 children, T. whipplei was significantly more common in patients with diarrhea (4%) than in those without (1.7%). A case-controlled study highlighted 58 patients suffering from pneumonia with the detection of T. whipplei in their bronchoalveolar fluids. Finally, a recent study detected T. whipplei in the blood of 36 febrile patients experiencing pulmonary symptoms in a rural area of Senegal. T. whipplei is definitively an agent of acute gastroenteritis, a cause of nonmalarial fever in Africa, and probably a cause of pulmonary infections.
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Tropheryma whipplei associated with diarrhoea in young children
Clinical Microbiology and Infection, 2016Co-Authors: Florence Fenollar, P Minodier, Herve Richet, A Boutin, R Laporte, V Bremond, Guilhem Noel, S Miramont, Samir Benkouiten, Jean Christophe LagierAbstract:Tropheryma whipplei was detected in preliminary studies in faeces of young children with diarrhoea and also in faeces of asymptomatic persons, not only in Europe but also in Africa. In this study, the link between this bacterium and the presence of acute diarrhoea was evaluated in a large group of children. From December 2009 to January 2013, rectal swabs collected from 3796 children in the emergency departments of university hospitals in Marseille, France, were analysed: 555 children (245 female and 310 male, from 6 days to 6 years old) with acute diarrhoea defined as at least three loose stools per day for <1 week and 3241 children (1444 female and 1797 male, from 22 days to 6 years old) without diarrhoea. Specific quantitative real-time PCR was performed to detect the presence of T. whipplei and of two enteric pathogens Clostridium difficile and Giardia duodenalis. Tropheryma whipplei was significantly more common in children with diarrhoea (22/555, 4%) than without (56/3241, 1.7%; p 0.001). Neither C. difficile nor G. duodenalis showed this association. For C. difficile, 39 of 531 (7.3%) children with diarrhoea were positive versus 184 of 3119 (5.9%) of children without diarrhoea (p 0.25). For G. duodenalis, 2 of 529 (0.37%) children with diarrhoea were positive versus 5 of 3119 (0.16%) children without diarrhoea (p 0.26). Tropheryma whipplei was found more commonly in autumn. Tropheryma whipplei is significantly associated with diarrhoea in children, suggesting that the bacterium may be a cause of acute diarrhoea.
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Tropheryma whipplei associated with diarrhoea in young children
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2016Co-Authors: Florence Fenollar, P Minodier, Herve Richet, A Boutin, R Laporte, V Bremond, Guilhem Noel, S Miramont, Samir Benkouiten, Jean Christophe LagierAbstract:Tropheryma whipplei was detected in preliminary studies in faeces of young children with diarrhoea and also in faeces of asymptomatic persons, not only in Europe but also in Africa. In this study, the link between this bacterium and the presence of acute diarrhoea was evaluated in a large group of children. From December 2009 to January 2013, rectal swabs collected from 3796 children in the emergency departments of university hospitals in Marseille, France, were analysed: 555 children (245 female and 310 male, from 6 days to 6 years old) with acute diarrhoea defined as at least three loose stools per day for
Jean Christophe Lagier - One of the best experts on this subject based on the ideXlab platform.
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Whipple's disease and Tropheryma whipplei infections: when to suspect them and how to diagnose and treat them
Current opinion in infectious diseases, 2018Co-Authors: Jean Christophe Lagier, Didier RaoultAbstract:Purpose of reviewThe delay between first clinical signs and diagnosis of Whipple's disease and Tropheryma whipplei infections is more than 6 years, and relapses are frequently observed, resulting in a need for clinicians to be aware of this infection.Recent findings18 FDG-PET is useful in the diagno
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Mesenteric lymphadenitis as a presenting feature of Whipple’s disease: Value of PCR analysis
Elsevier, 2018Co-Authors: Lucie Wartique, Didier Raoult, Jean Christophe Lagier, Yvan Jamilloux, Pascal SèveAbstract:Whipple’s disease (WD) is a rare chronic and systemic infection caused by the ubiquitous actinomycete Tropheryma whipplei. A case of localized infection with mesenteric adenopathy associated with a prolonged unexplained fever is reported herein. Screening by PCR on saliva and stool was positive, and T. whipplei was formally identified by specific PCR on duodenal and mesenteric adenopathy biopsies. Histological analysis did not demonstrate periodic acid–Schiff-positive macrophages or positive T. whipplei immunochemistry in either the duodenal mucosa or mesenteric nodes. Treatment with hydroxychloroquine and doxycycline allowed a rapid resolution of symptoms, and subsequent saliva and stool PCR results were negative. Keywords: Tropheryma whipplei, Whipple’s disease, Polymerase chain reaction, Mesenteric lymphadeniti
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Acute infections caused by Tropheryma whipplei
Future Microbiology, 2017Co-Authors: Jean Christophe Lagier, Florence Fenollar, Didier RaoultAbstract:Tropheryma whipplei is the causative bacterium of Whipple's disease. Its first culture has led to an enlargement of the field of the caused infections. Here, we comprehensively review acute T. whipplei infections. In a cohort study featuring 4000 children, T. whipplei was significantly more common in patients with diarrhea (4%) than in those without (1.7%). A case-controlled study highlighted 58 patients suffering from pneumonia with the detection of T. whipplei in their bronchoalveolar fluids. Finally, a recent study detected T. whipplei in the blood of 36 febrile patients experiencing pulmonary symptoms in a rural area of Senegal. T. whipplei is definitively an agent of acute gastroenteritis, a cause of nonmalarial fever in Africa, and probably a cause of pulmonary infections.
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Tropheryma whipplei associated with diarrhoea in young children
Clinical Microbiology and Infection, 2016Co-Authors: Florence Fenollar, P Minodier, Herve Richet, A Boutin, R Laporte, V Bremond, Guilhem Noel, S Miramont, Samir Benkouiten, Jean Christophe LagierAbstract:Tropheryma whipplei was detected in preliminary studies in faeces of young children with diarrhoea and also in faeces of asymptomatic persons, not only in Europe but also in Africa. In this study, the link between this bacterium and the presence of acute diarrhoea was evaluated in a large group of children. From December 2009 to January 2013, rectal swabs collected from 3796 children in the emergency departments of university hospitals in Marseille, France, were analysed: 555 children (245 female and 310 male, from 6 days to 6 years old) with acute diarrhoea defined as at least three loose stools per day for <1 week and 3241 children (1444 female and 1797 male, from 22 days to 6 years old) without diarrhoea. Specific quantitative real-time PCR was performed to detect the presence of T. whipplei and of two enteric pathogens Clostridium difficile and Giardia duodenalis. Tropheryma whipplei was significantly more common in children with diarrhoea (22/555, 4%) than without (56/3241, 1.7%; p 0.001). Neither C. difficile nor G. duodenalis showed this association. For C. difficile, 39 of 531 (7.3%) children with diarrhoea were positive versus 184 of 3119 (5.9%) of children without diarrhoea (p 0.25). For G. duodenalis, 2 of 529 (0.37%) children with diarrhoea were positive versus 5 of 3119 (0.16%) children without diarrhoea (p 0.26). Tropheryma whipplei was found more commonly in autumn. Tropheryma whipplei is significantly associated with diarrhoea in children, suggesting that the bacterium may be a cause of acute diarrhoea.
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Tropheryma whipplei associated with diarrhoea in young children
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2016Co-Authors: Florence Fenollar, P Minodier, Herve Richet, A Boutin, R Laporte, V Bremond, Guilhem Noel, S Miramont, Samir Benkouiten, Jean Christophe LagierAbstract:Tropheryma whipplei was detected in preliminary studies in faeces of young children with diarrhoea and also in faeces of asymptomatic persons, not only in Europe but also in Africa. In this study, the link between this bacterium and the presence of acute diarrhoea was evaluated in a large group of children. From December 2009 to January 2013, rectal swabs collected from 3796 children in the emergency departments of university hospitals in Marseille, France, were analysed: 555 children (245 female and 310 male, from 6 days to 6 years old) with acute diarrhoea defined as at least three loose stools per day for
Hubert Lepidi - One of the best experts on this subject based on the ideXlab platform.
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treatment of classic whipple s disease from in vitro results to clinical outcome
Journal of Antimicrobial Chemotherapy, 2014Co-Authors: Jean Christophe Lagier, Hubert Lepidi, Florence Fenollar, Roch Giorgi, Matthieu Million, Didier RaoultAbstract:OBJECTIVES: Patients with classic Whipple's disease have a lifetime defect in immunity to Tropheryma whipplei and frequently develop treatment failures, relapses or reinfections. Empirical treatments were tested before culture was possible, but the only in vitro bactericidal treatment consists of a combination of doxycycline and hydroxychloroquine. METHODS: Our laboratory has been a reference centre since the first culturing of Tropheryma whipplei, and we have tested 27,000 samples by PCR and diagnosed 250 cases of classic Whipple's disease. We report here the clinical course of patients who were followed by one of our group. RESULTS: Of 29 patients, 22 (76%) were previously treated with immunosuppressive drugs, 26 (90%) suffered from arthralgias and 22 (76%) exhibited weight loss. Intravenous initial treatment was paradoxically associated with an increased risk of failure (P = 0.0282). Treatment with doxycycline and hydroxychloroquine (± sulfadiazine or trimethoprim/sulfamethoxazole) was associated with a better outcome (0/13 failures), whereas all 14 patients who were first treated with trimethoprim/sulfamethoxazole and referred to us (P < 0.0001) experienced failure. Among the patients treated with doxycycline and hydroxychloroquine after previous antibiotic treatments, two presented with a reinfection caused by different T. whipplei strains. Finally, serum therapeutic drug monitoring allowed us to detect a lack of compliance in the only patient with failure among the 22 patients treated with lifetime doxycycline. CONCLUSIONS: In vitro results were confirmed by clinical outcomes and trimethoprim/sulfamethoxazole was associated with failures. The recommended management is a combination of doxycycline and hydroxychloroquine for 1 year, followed by doxycycline for the patient's lifetime along with stringent therapeutic drug monitoring.
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Tropheryma whipplei endocarditis
Emerging Infectious Diseases, 2013Co-Authors: Florence Fenollar, M Celard, Pierre-edouard Fournier, Hubert Lepidi, Jean Christophe Lagier, Didier RaoultAbstract:Tropheryma whipplei endocarditis differs from classic Whipple disease, which primarily affects the gastrointestinal system. We diagnosed 28 cases of T. whipplei endocarditis in Marseille, France, and compared them with cases reported in the literature. Specimens were analyzed mostly by molecular and histologic techniques. Duke criteria were ineffective for diagnosis before heart valve analysis. The disease occurred in men 40–80 years of age, of whom 21 (75%) had arthralgia (75%); 9 (32%) had valvular disease and 11 (39%) had fever. Clinical manifestations were predominantly cardiologic. Treatment with doxycycline and hydroxychloroquine for at least 12 months was successful. The cases we diagnosed differed from those reported from Germany, in which arthralgias were less common and previous valve lesions more common. A strong geographic specificity for this disease is found mainly in eastern-central France, Switzerland, and Germany. T. whipplei endocarditis is an emerging clinical entity observed in middle-aged and older men with arthralgia.
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systemic Tropheryma whipplei clinical presentation of 142 patients with infections diagnosed or confirmed in a reference center
Medicine, 2010Co-Authors: Jean Christophe Lagier, Hubert Lepidi, Didier Raoult, Florence FenollarAbstract:AbstractCulture of Tropheryma whipplei, the agent of Whipple disease (WD), was achieved in our laboratory in 2000, allowing new perspectives for the diagnosis of this disease and for the description of other potential clinical manifestations caused by this microorganism. Since 2000, we have develope
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Tropheryma whipplei in the skin of patients with classic Whipple's disease.
The Journal of infection, 2010Co-Authors: Emmanouil Angelakis, Hubert Lepidi, Florence Fenollar, Marie-laure Birg, Didier RaoultAbstract:Positive Tropheryma whipplei PCR results in skin biopsies were frequent in patients with classic Whipple's disease without skin manifestations. The bacterium was alive, as a strain was successfully cultured. The skin may be a reservoir for T. whipplei and may be helpful in the non-invasive diagnosis of the disease.
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Tropheryma whipplei Glycosylation in the Pathophysiologic Profile of Whipple’s Disease
The Journal of Infectious Diseases, 2009Co-Authors: Cyrille J. Bonhomme, Patrick Fourquet, Eric Ghigo, Patricia Renesto, Hubert Lepidi, Benoit Desnues, Florence Fenollar, Bernard Henrissat, Jean-louis MegeAbstract:Background. Tropheryma whipplei is a bacterium commonly found in people with Whipple’s disease, a rare systemic chronic infection. In the present study, we hypothesized that bacterium glycosylation may impair the immune response. Methods. Bacterial extracts were analyzed by glycostaining, and reactive proteins, identified by matrix-assisted laser desorption/ionization‐time-of-flight (MALDI-TOF) mass spectometry, were purified to generate antibodies that could be used in immunofluorescence studies. The reactivity of serum samples obtained from patients and asymptomaticcarrierswastestedagainstnativeordeglycosylatedbacteria,forwhichthefateinmacrophageswasalso investigated. Results. To our knowledge, we evidenced, for the first time in T. whipplei, a 110-kDa glycoprotein containing sialicacid.Thisprotein,identifiedasanWnt1-induciblesignalingpathway(WiSP)protein,isassociatedwithperiodic acid‐Schiff (PAS) staining in infected intramacrophage biofilm. Consistent with the lack of enzymes required for the glycosylation pathway in this bacterium, the glycoproteins disappear during in vitro axenic subcultures, whereas humantranscriptomeanalysisrevealstheup-regulationofcorrespondinggeneswithininfectedmacrophages.Proteic antigensarenotrecognizedbytheserumsamplesobtainedfrompatientscomparedwiththoseobtainedfromnonsick carriers,andT.whippleithatexhibitsalowglycosylationprofiledoesnotefficientlymultiplyinmacrophagesinvitro. Conclusions. T. whipplei glycosylation is likely to impair antibody-mediated immune recognition in patients. Such an intracellular antigen masking system in bacteria has not previously been described. Tropheryma whipplei is a gram-positive bacterium responsible for Whipple’s disease (WD) [1], a rare and chronic infection resulting in several heterogeneous clinical characteristics with or without gastrointestinal symptoms [2]. Polymerase chain reaction (PCR) analysis and sequencing of the 16S ribosomal DNA (rDNA)
Thomas Schneider - One of the best experts on this subject based on the ideXlab platform.
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Whipple's Disease: Diagnostic Value of rpoB Gene PCR from Peripheral Blood Mononuclear Cells.
Molecular Diagnosis and Therapy, 2018Co-Authors: Kathleen Weigt, Alexandra Wiessner, Kristina Allers, Florence Fenollar, Didier Raoult, Annette Moter, Thomas SchneiderAbstract:Introduction Chronic infection with Tropheryma whipplei, known as Whipple’s disease (WD), classically affects the gastrointestinal tract, but any organ system may be affected, and isolated manifestations occur. Reliable diagnosis based on a combination of periodic acid–Schiff (PAS) staining, T. whipplei-specific immunohistochemistry (IHC), and polymerase chain reaction (PCR) from duodenal biopsies may be challenging in cases without classical gastrointestinal infection, so the need for additional diagnostic materials is urgent. Objective Our objective was to evaluate additional diagnostic possibilities for WD. Methods We analyzed samples from 20 patients with WD and 18 control subjects in a prospective observational pilot study. In addition to WD diagnosis by PAS staining, T. whipplei-specific IHC and PCR of duodenal or extra intestinal tissues, whole EDTA blood, peripheral blood mononuclear cells (PBMCs) and PBMC fractions enriched with or depleted of cluster of differentiation (CD)-14+ cells were examined using T. whipplei rpoB gene PCR. Results Tropheryma whipplei DNA was detected in 35 of 60 (58.3%) preparations from 16 of 20 patients with WD, most of whom lacked gastrointestinal signs and characteristic PAS-positive duodenal macrophages. Conclusion This study provides evidence for the potential suitability of blood, particularly PBMCs, as material to assist in the diagnosis of WD via rpoB gene real-time PCR. Thus, PCR from blood preparations can be helpful for diagnostic decision making in atypical cases of WD.
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Tropheryma whipplei infection and Whipple's disease
The Lancet. Infectious diseases, 2016Co-Authors: Thomas Marth, Verena Moos, Christian D. Muller, Federico Biagi, Thomas SchneiderAbstract:Summary Recent advances in medical microbiology, epidemiology, cellular biology, and the availability of an expanded set of diagnostic methods such as histopathology, immunohistochemistry, PCR, and bacterial culture have improved our understanding of the clinical range and natural course of Tropheryma whipplei infection and Whipple's disease. Interdisciplinary and transnational research activities have contributed to the clarification of the pathogenesis of the disorder and have enabled controlled trials of different treatment strategies. We summarise the current knowledge and new findings relating to T whipplei infection and Whipple's disease.
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gastrointestinal diagnosis of classical whipple disease clinical endoscopic and histopathologic features in 191 patients
Medicine, 2015Co-Authors: Ute Gunther, Annette Moter, Verena Moos, Gabriel Offenmuller, Gerrit Oelkers, Walther Heise, Christoph Loddenkemper, Thomas SchneiderAbstract:AbstractClassic Whipple disease (CWD) is a systemic infection caused by Tropheryma whipplei. Different diagnostic tools have been developed over the last decades: periodic acid-Schiff (PAS) staining, T whipplei-specific polymerase chain reaction (PCR), and T whipplei-specific immunohistochemistry (I
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Validation of an rpoB Gene PCR Assay for Detection of Tropheryma whipplei: 10 Years' Experience in a National Reference Laboratory
Journal of clinical microbiology, 2013Co-Authors: Annette Moter, Alexandra Wiessner, Thomas Schneider, Verena Moos, Dinah Schmiedel, Annett Petrich, Judith Kikhney, Ulf B. Göbel, Udo ReischlAbstract:The performance of a real-time PCR assay targeting the Tropheryma whipplei rpoB gene was evaluated using test strains and 1,236 clinical specimens in a national reference laboratory. The novel rpoB-PCR assay proved to be specific, revealed improved analytical sensitivity, and substantially accelerated detection of T. whipplei DNA in clinical specimens.
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Infektionen mit Tropheryma whipplei
Der Pathologe, 2011Co-Authors: Verena Moos, Christoph Loddenkemper, Thomas SchneiderAbstract:Der M. Whipple ist eine durch den ubiquitar vorkommenden Erreger Tropheryma whipplei verursachte multisystemische Infektion. Immunologische Wirtsfaktoren ermoglichen den klassischen M. Whipple, aber T. whipplei kann auch bei gesunden Ausscheidern, selbstlimitierten Infektionen und isolierter infektioser Endokarditis nachgewiesen werden. Die genetische Pradisposition und nicht der Genotyp des Erregers beeinflussen die Infektion. Erst moderne diagnostische Methoden zeigen die grose Bandbreite des M. Whipple. Besonders die isolierte T.-whipplei-induzierte Endokarditis kann nur nach Entfernung der betroffenen Klappe diagnostiziert werden. Das einzige prospektiv evaluierte Behandlungsschema fur den M. Whipple besteht aus einer intravenosen Induktionstherapie mit Ceftriaxon oder Merophenem und einer oralen Erhaltungstherapie mit Trimethoprim-Sulfamethoxazol. Bei M. Whipple mit inflammatorischem Immunrekonstitutionssyndrom oder bei entzundlichen zerebralen Lasionen sollte zusatzlich mit Steroiden therapiert werden, um schwere Gewebeschaden zu verhindern.
