High Frequency of Tropheryma whipplei in Culture-Negative Endocarditis

Geißdörfer, Walter; Moos, Verena; Moter, Annette; Loddenkemper, Christoph; Jansen, Andreas; Tandler, R.; Morguet, Andreas J.; Fénollar, Florence; Raoult, Didier; Bogdan, Christian; Schneider, Thomas

doi:10.1128/jcm.05531-11

Cited by 125 publications

(103 citation statements)

References 32 publications

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“…However, one should be aware that PAS staining has a poor specificity in brain biopsy samples (130,177). Depending on the localization of the infection, T. whipplei can also be found in bone marrow, lymph nodes, skin, liver, muscle, eye, and lung (10,62,103,113,120,137,178). It is important to realize that in chronic localized infections, PAS-stained duodenal biopsy specimens may be negative (102,130,162,179,180).…”

Section: Histopathology (Pas and Hematoxylin-and-eosin Stain [Hande]mentioning

confidence: 99%

“…In 255/1,135 (22%) of the cases, a bacterial cause could be established by a combination of molecular methods and culture. Surprisingly, 16/255 (6.3%) of the patients with a proven bacterial infection (1.5% of the total population) carried T. whipplei, making it the fourth most frequent pathogen identified from these proven infectious cases (103). Follow-up of these patients revealed that most of these T. whipplei-positive patients displayed no symptoms of classic Whipple's disease and had thus neither been diagnosed nor treated properly for their potentially lethal T. whipplei infection.…”

Section: Localized Chronic Infectionsmentioning

confidence: 99%

“…The first reported localized T. whipplei endocarditis case was diagnosed by broad-range bacterial PCR analysis (153). As there are no evident diagnostic criteria, clinicians should be especially alert for a potential T. whipplei endocarditis when dealing with white men who are around 50 years of age with cardiac symptoms like heart failure, large vegetations, and destruction of the heart valve, acute ischemic stroke, and embolic events (103,113,154). Of all patients with blood culture-negative endocarditis, PCR revealed the presence of a T. whipplei infection in 1.9 to 6.3% of patients (103,113,155).…”

Section: Localized Chronic Infectionsmentioning

confidence: 99%

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Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

et al. 2017

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SUMMARY Whipple's disease is a rare infectious disease that can be fatal if left untreated. The disease is caused by infection with Tropheryma whipplei, a bacterium that may be more common than was initially assumed. Most patients present with nonspecific symptoms, and as routine cultivation of the bacterium is not feasible, it is difficult to diagnose this infection. On the other hand, due to the generic symptoms, infection with this bacterium is actually quite often in the differential diagnosis. The gold standard for diagnosis used to be periodic acid-Schiff (PAS) staining of duodenal biopsy specimens, but PAS staining has a poor specificity and sensitivity. The development of molecular techniques has resulted in more convenient methods for detecting T. whipplei infections, and this has greatly improved the diagnosis of this often missed infection. In addition, the molecular detection of T. whipplei has resulted in an increase in knowledge about its pathogenicity, and this review gives an overview of the new insights in epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of Tropheryma whipplei infections.

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Section: Histopathology (Pas and Hematoxylin-and-eosin Stain [Hande]mentioning

confidence: 99%

Section: Localized Chronic Infectionsmentioning

confidence: 99%

Section: Localized Chronic Infectionsmentioning

confidence: 99%

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Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

et al. 2017

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“…T. whipplei causes up to 6% of cases of culture-negative endocarditis (7,20,21). C. acnes, a rare cause of endocarditis, may cause culture-negative endocarditis due to the requirement for prolonged blood culture incubation for growth of some strains (14); in addition, some strains may not grow in blood cultures.…”

Section: Diagnosis Of Culture-negative Endocarditismentioning

confidence: 99%

Laboratory Diagnosis of Infective Endocarditis

et al. 2017

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Infective endocarditis is life-threatening; identification of the underlying etiology informs optimized individual patient management. Changing epidemiology, advances in blood culture techniques, and new diagnostics guide the application of laboratory testing for diagnosis of endocarditis. Blood cultures remain the standard test for microbial diagnosis, with directed serological testing (i.e., Q fever serology, Bartonella serology) in culture-negative cases. Histopathology and molecular diagnostics (e.g., 16S rRNA gene PCR/sequencing, Tropheryma whipplei PCR) may be applied to resected valves to aid in diagnosis. Herein, we summarize recent knowledge in this area and propose a microbiologic and pathological algorithm for endocarditis diagnosis. KEYWORDS clinical microbiology, endocarditisD espite recent advances in diagnostic and therapeutic strategies, the mortality of infective endocarditis remains high, with more than one-third of patients affected dying within a year following diagnosis (1, 2). Identification of the specific underlying microbial etiology is essential for optimal patient management; delays in microbial diagnosis may contribute to late initiation of effective antimicrobial therapy, influencing morbidity and mortality. The modified Duke criteria provide a basic scheme for diagnosis and definition of endocarditis and rely on detection of infecting microorganisms in addition to echocardiographic and clinical findings (1, 3). The finding of two (or more) blood cultures positive for a typical microorganism consistent with infective endocarditis is a major criterion for infective endocarditis as is positive Q fever serology (anti-phase I IgG titer of Ն1:800). Echocardiographic findings are also considered but are beyond the scope of the manuscript.The epidemiology of endocarditis, which has shifted in recent years, should guide diagnostic testing. Today, staphylococci and streptococci combined cause ϳ80% of cases. Staphylococcus aureus remains the dominant pathogen, associated with ϳ25% to ϳ30% of cases, while coagulase-negative staphylococci account for ϳ11% of cases (4, 5). Streptococci, primarily viridans group streptococci, cause ϳ30% of cases, with Streptococcus gallolyticus (a Streptococcus bovis group member) being involved in ϳ20% to ϳ50% of streptococcal cases (4, 5). Enterococci, especially Enterococcus faecalis, account for ϳ10% of cases (4, 5). Gram-negative bacilli account for ϳ5% of cases and include the HACEK group organisms (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella species) and, less commonly, non-HACEK Gramnegative bacilli, such as the Enterobacteriaceae and nonfermenting Gram-negative bacilli. Fungi are rare endocarditis causes, with Candida species being the most common. A number of uncultivable or challenging to cultivate organisms cause endocarditis, the most common of which are Coxiella burnetii, Bartonella species, and Tropheryma whipplei.Endocarditis most often involves the aortic or mitral valves, with tricuspid valve involvement accoun...

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“…A forma mais comum de apresentação é uma síndrome de má absorção, com diarreia e perda ponderal frequentemente associados a dor abdominal, febre, linfadenopatias periféricas e abdominais 3,5,6 . O envolvimento cardíaco na DW pode afectar qualquer estrutura, estando essencialmente descritos casos de endocardite, com a maioria diagnosticada após análise das válvulas ressecadas 7,8,9 . A sintomatologia osteoarticular está presente em cerca de 90% dos casos, geralmente precede o diagnóstico em cerca de 10 anos e caracteriza-se por oligo ou poliartralgias simétricas, migratórias, não destrutivas e seronegativas.…”

Section: Discussionunclassified

Uma causa pouco habitual de diarreia

Pires¹,

Batouxas²,

Loza³

et al. 2015

Gal. Clin.

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ResumoA diarreia crónica é uma manifestação comum de doenças gastrointestinais que pode estar associada às mais diversas etiologias. Estima-se que a sua prevalência nos países ocidentais seja de 4-5%. A sua abordagem diagnóstica é complexa atendendo à multiplicidade de causas subjacentes. Os autores apresentam o caso clínico de um paciente admitido com quadro de diarreia com 6 meses de evolução e perda ponderal de 18 Kg nesse período, cuja investigação diagnóstica revelou tratar-se de um caso de doença de Whipple. Palavras chave. Whipple's disease; Diarreia crónica; Tropheryma whipplei AbstractChronic diarrhea is a common manifestation of gastrointestinal diseases that may be associated with many different etiologies. It is estimated that its prevalence in Western countries is 4-5%. Its diagnostic approach is complex given the multitude of underlying causes. The authors present a clinical case of a patient admitted with diarrhea with 6 months of evolution and weight loss of 18 kg during this period, whose diagnostic investigation revealed that it was a case of Whipple's disease. Keywords: Whipple's disease, Chronic diarrhea, Tropheryma whipplei Introdução A diarreia é uma manifestação clínica comum de doenças do foro gastrointestinal que pode ser definida em termos de volume, frequência e características das dejecções. Para a maior parte dos pacientes, o conceito de diarreia assenta na consistência das dejecções, que é determinada pela capacidade de retenção de água pelas fezes, o que na prática clínica é difícil de determinar. Outros critérios, tais como um número superior a 3 dejeções ou um peso de dejecções superior a 200 g/ dia são meios alternativos de definição da diarreia mas que carecem de especificidade pela variabilidade que apresentam na população assim como pela influência dos hábitos alimentares. Assim, em termos pragmáticos, a diarreia é a passagem anormal de fezes moles ou líquidas, mais de três vezes ao dia e/ou de volume de fezes maior do que 200 g / dia, sendo considerada crónica quando os sintomas persistem para além das 4 semanas. Estima-se que a prevalência da diarreia cró-nica seja 4 a 5% nos países ocidentais 1 . Na prática clínica, uma miríade de patologias gastrointestinais cursam com diarreia crónica (tabela 1), podendo cursar com síndromes de má absorção e consequente défices nutricionais e má nutrição. Nos países subdesenvolvidos, é frequentemente causada por infecções bacterianas crónicas, micobacterianas ou parasitárias. Nos países desenvolvidos, a doença inflamatória intestinal, o síndrome de intestino irritável, as síndromas de má absorção e infecções crónicas são as causas mais comuns. O tratamento da diarreia cró-nica deve ser dirigido à causa e à correção dos distúrbios hidrolectrolíticos e nutricionais 1,2 . Caso clínicoHomem de 78 anos, reformado da construção civil, natural de Portugal e residente na Alemanha desde os 20 anos. Tem antecedentes de hipertensão arterial essencial, diabetes mellitus tipo

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High Frequency of Tropheryma whipplei in Culture-Negative Endocarditis

Cited by 125 publications

References 32 publications

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

Laboratory Diagnosis of Infective Endocarditis

Uma causa pouco habitual de diarreia

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