Epidemiology of Whipple’s Disease in the USA Between 2012 and 2017: A Population-Based National Study

Elchert, Jamie Ann; Mansoor, Emad; Abou-Saleh, Mohannad; Cooper, Gregory S.

doi:10.1007/s10620-018-5393-9

Cited by 56 publications

(48 citation statements)

References 43 publications

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“…Besides the classical presentations with chronic diarrhoea and malabsorption, clinical presentations include endocarditis, central nervous system (CNS) involvement, uveitis, arthritis, and diskitis without gastrointestinal manifestations and/or with normal gastrointestinal histology [9]. Indeed, patients with WD were more likely to have associated arthritis, CNS manifestations, endocarditis, diabetes, malignancy, dementia, vitamin D deficiency, iron deficiency, chemotherapy, weight loss, abdominal pain, and lymphadenopathy [10].…”

Section: Discussionmentioning

confidence: 99%

Seronegative Arthritis and Whipple Disease: Risk of Misdiagnosis in the Era of Biologic Agents

Quartuccio

Giovannini

Pizzolitto

et al. 2019

Case Reports in Rheumatology

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We report 2 cases of Whipple disease (WD), previously diagnosed as seronegative polyarthritis and treated for several years with immunosuppressive agents, accordingly. Both cases had been treated over years with cDMARDs and bDMARDs. The first patient was a 48-year-old male, who developed a life-threatening disease characterized by fever, significant weight loss, and bloody diarrhoea, supported with RBC transfusions. The second patient was a 55-year-old man, presenting with arthritis, fever, serositis, lymphadenopathy, thoracic rash, and systemic inflammation; at the beginning he was diagnosed as adult onset Still's disease. He was treated with steroids and antitumour necrosis factor agents, but showed no improvement. Both patients were eventually treated with antimicrobial therapy for WD with dramatic improvement and no clinical relapse in 6 months. This paper reviews the literature on WD mimicking chronic inflammatory arthritis. WD may lead to chronic seronegative arthritis that might often be misrecognized. Importantly, patients treated with bDMARDs and glucocorticoids might develop a life-threatening disease. Therefore, WD should be suspected and excluded in patients showing resistance or frequent recurrence of chronic arthritis, if seronegative, under treatment with bDMARDs, especially in the presence of new, unexpected sign and/or symptoms.

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Section: Discussionmentioning

confidence: 99%

Seronegative Arthritis and Whipple Disease: Risk of Misdiagnosis in the Era of Biologic Agents

Quartuccio

Giovannini

Pizzolitto

et al. 2019

Case Reports in Rheumatology

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“…The most severe form includes neuropsychiatric manifestations, such as ophthalmoplegia, myoclonus, and dementia. 66 Endoscopic and pathological features. Upper gastrointestinal disease occurs in the duodenum and more distal small intestine.…”

Section: Tropheryma Whipplei (Whipple's Disease)mentioning

confidence: 99%

“…Whipple’s disease classically presents with diarrhoea, weight loss, fever, abdominal lymphadenopathy, arthralgia, and cardiovascular and pulmonary symptoms. The most severe form includes neuropsychiatric manifestations, such as ophthalmoplegia, myoclonus, and dementia 66 …”

Section: Bacterial Infection Of the Upper Gastrointestinal Tractmentioning

confidence: 99%

Infectious diseases of the upper gastrointestinal tract

Panarelli

2020

Histopathology

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A broad spectrum of pathogens produce gastrointestinal disease. The ongoing spread of human immunodeficiency virus/acquired immune deficiency syndrome, the increased use of immunosuppressive therapy and the persistence of overcrowding and suboptimal sanitation in underdeveloped areas facilitate both disease transmission from environmental and foodborne sources and person‐to‐person transmission. Clinicians increasingly rely on endoscopic biopsy sample interpretation to diagnose gastrointestinal infections. Thus, pathologists must be aware of diagnostic features of a variety of microbial pathogens. Detection with molecular techniques also allows for correlation between infectious agents and their histopathological features, which has expanded our knowledge of the inflammatory changes produced by infectious agents. This review covers infectious disorders of the upper gastrointestinal tract encountered in surgical pathology. Clinical, endoscopic and pathological features are presented. The review emphasises morphological features of viruses, bacteria, fungi and parasites that may be found in tissue samples, and the inflammatory patterns that they produce. Differential diagnoses and useful ancillary techniques are discussed.

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“…Whipple’s disease (WD) is a rare infection with Tropheryma whipplei with an estimated prevalence of 1.1 to 9.8 cases per million inhabitants and an annual incidence of 1 to 6 per 10 million inhabitants (1-3). In small case series from Germany, Spain and north-western Italy, the maximum incidence of WD was in persons between 40-60 years of age, of whom 72-96% were middle-aged Caucasian men (2-7).…”

Section: Introductionmentioning

confidence: 99%

A Paradoxical Screening Serological Assay for the Diagnosis of Whipple’s Disease (infection with Tropheryma whipplei)

Liew

Nguyen

Waidyatillake

et al. 2021

Preprint

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Whipple’s disease (WD) is a rare infection due to Tropheryma whipplei. Following in-vitro cultivation of T. whipplei, an indirect-immunofluorescence serological assay (IFA) was developed. We tested the hypothesis that this assay could be used to either identify WD patients, or rule out WD, in patients in whom the diagnosis is being considered, based on the antibody titers of their IgM and IgG antibody responses. In this small study fourteen WD patients and 22 healthy volunteers’ sera were obtained from across Australia. All specimens were coded and de-identified before testing. A patient with an IgG antibody titer of ≤1:16 may have WD [sensitivity 57% (8/14) and specificity close to 100% (22/22)]. High IgM antibody titers (≥1:256) were more common in WD patients [sensitivity 50% (7/14) and specificity 86% (19/22)] than in controls. The area under Receiver-Operator-Characteristic curve for IgG in the IFA assay was 0.84 (95% CI 0.69-1.00). At an IgG antibody titer of ≤1:16 the Youden’s index was 0.57. WD patients’ under-produce IgG antibody to T.whipplei but are more likely to over-produce IgM antibodies. This screening IFA serological assay may be clinically useful in detecting those with a possible diagnosis of WD. Patients with an IgG antibody titer of ≤1:16 and an IgM antibody titer of ≥1:256 may have WD and should proceed to a tissue biopsy and PCR for confirmation. Further validation of this assay, by increasing the sample size, by testing it in patients with non-WD disease and trialing in other countries should be undertaken.

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Epidemiology of Whipple’s Disease in the USA Between 2012 and 2017: A Population-Based National Study

Cited by 56 publications

References 43 publications

Seronegative Arthritis and Whipple Disease: Risk of Misdiagnosis in the Era of Biologic Agents

Seronegative Arthritis and Whipple Disease: Risk of Misdiagnosis in the Era of Biologic Agents

Infectious diseases of the upper gastrointestinal tract

A Paradoxical Screening Serological Assay for the Diagnosis of Whipple’s Disease (infection with Tropheryma whipplei)

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