Diagnostic Approach for Classic Compared With Localized Whipple Disease

Crews, Nicholas R.; Cawcutt, Kelly; Pritt, Bobbi S.; Patel, Robin; Virk, Abinash

doi:10.1093/ofid/ofy136

Cited by 30 publications

(26 citation statements)

References 30 publications

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“…The classical symptoms reported by this patients starts with arthritis (73-80%) followed by persistent diarrhea, other chronic gastrointestinal symptoms (72-81%), and weight loss (79-93%) [2,3]. Other acute and chronic T. whipplei localized manifestations are also been reported in the absence of the classic gastrointestinal involvement [4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 62%

<em>Tropheryma whipplei</em> in Immunocompromised Children in Iran: A Preliminary Study

Shams¹,

Rezaei²,

Beltrame³

et al. 2021

Preprint

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Background: Tropheryma whipplei is the causative pathogen of Whipple’s disease and other acute and chronic manifestations. Children have been identified as reservoirs of this bacterium especially in low-middle income countries. No information is currently available on the dissemination of T. whipplei in Iran. Therefore, the aim of this study was to investigate the presence of T. whipplei in children with immunodeficiency. Methods: This cross-sectional study was performed from July 2018 to February 2019 in Qom province (central Iran). Stool samples were collected from immuno-compromised children. T. whipplei was tested by SYBR Green and Taq-Man Real-time PCR assays. For confirmation, sequencing of the isolated bacteria was done. Results: One hundred and 30 children with a mean age of 56.7 months were enrolled. Acute lymphocytic leukemia was the most reported immunodeficient disease (77%), followed by non-Hodgkin lymphoma and retinoblastoma. The majority of the children were undergoing chemotherapy during the study. Thirteen (10%) children had T. whipplei DNA in the collected stools. Sequencing results confirmed T. whipplei identification in all the cases. Eight out of 70 (11.4%) children under 5 years old resulted positive. Conclusion: This is the first study showing the circulation of T. whipplei among immunocompromised children in Iran. More epidemiological studies are needed to evaluate the prevalence of this pathogen in different risk groups in Iran and to increase the knowledge of its rare clinical manifestations.

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Section: Introductionmentioning

confidence: 62%

<em>Tropheryma whipplei</em> in Immunocompromised Children in Iran: A Preliminary Study

Shams¹,

Rezaei²,

Beltrame³

et al. 2021

Preprint

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“…The classic form, more common in caucasian middle-aged men, is often characterised by arthralgia (reported in most patients as the first prodromal sign), weight loss and gastrointestinal symptoms such as diarrhoea and generalised abdominal pain, since the small bowel is the most frequently affected site 9–14…”

Section: Discussionmentioning

confidence: 99%

Whipple’s disease: imaging contribution for a challenging case

et al. 2020

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Whipple’s disease is a rare and difficult-to-diagnose infectious disease, related to infection by gram-positive bacillum Tropheryma whipplei. Clinical manifestations are very variable, but the classic form usually begins with recurring arthritis, followed several years later by non-specific abdominal symptoms, leading to late diagnosis. We present the case of a 52-year-old man who was admitted in the emergency department with an insidious clinical picture characterised by weight loss, abdominal pain, diarrhoea and arthralgias. An abdominal ultrasound was performed, showing findings suggestive of Whipple’s disease, which, in conjunction with the clinical and laboratory findings, allowed the diagnosis to be correctly addressed. Upper endoscopy with duodenal biopsy revealed findings compatible with Whipple’s disease, and the diagnosis was also confirmed through PCR techniques of blood. The patient was given antibiotic therapy, with rapid and substantial clinical improvement.

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“…Many symptoms present in various forms and combinations. Not infrequently, cases present with localized forms (endocarditis, encephalitis) without gastrointestinal symptoms [2, 7, 9, 13, 15–17]. Diagnosis of WD, therefore, remains challenging despite the recent advancements in medical and technical tools [15, 16, 18].…”

Section: Discussionmentioning

confidence: 99%

Whipple’s Disease Affecting Ileal Peyer’s Patches: The First Case Report

Sid’Amar¹,

Puppa

2019

Case Reports in Pathology

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Whipple’s disease is a rare chronic systemic bacterial infectious disease which can affect multiple organs, with a wide clinical spectrum encompassing many symptoms presenting in various forms and combinations. In the cases where the gastrointestinal tract is implicated, the more frequent localizations involve the small bowel, especially the duodenum. A case of a 67-year-old man who underwent clinical investigation after presenting with a progressive weight loss and showing a hypercapting right paracoeliac adenopathy at PET-CT scan is reported herein. A gastroscopy and a colonoscopy were done. The biopsies of the endoscopically normal ileal mucosa encompassed some submucosal Peyer’s patches. Histological examination of this lymphoid tissue revealed several foamy macrophages which turned out positive on periodic acid-Schiff special staining. Polymerase chain reaction of the microdissected lymph follicles allowed for confirming Whipple’s disease diagnosis. A targeted antibiotic treatment administrated to the patient led to a rapid clinical improvement. This finding of a previously unreported localization of infected macrophages in Whipple’s disease suggests that sampling the organized mucosal-submucosal lymphoid tissue may increase the diagnostic yield in endoscopic biopsies.

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Diagnostic Approach for Classic Compared With Localized Whipple Disease

Cited by 30 publications

References 30 publications

<em>Tropheryma whipplei</em> in Immunocompromised Children in Iran: A Preliminary Study

<em>Tropheryma whipplei</em> in Immunocompromised Children in Iran: A Preliminary Study

Whipple’s disease: imaging contribution for a challenging case

Whipple’s Disease Affecting Ileal Peyer’s Patches: The First Case Report

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