Prevalence and risk factor assessment of Tropheryma whipplei in a rural community in Gabon: a community-based cross-sectional study

Abstract

Tropheryma whipplei is the causative agent of Whipple's disease and has been detected in stools of asymptomatic carriers. Colonization has been associated with precarious hygienic conditions. There is a lack of knowledge about the epidemiology and transmission characteristics on a population level, so the aim of this study was to determine the overall and age-specific prevalence of T. whipplei and to identify risk factors for colonization. This molecular epidemiological survey was designed as a cross-sectional study in a rural community in Central African Gabon and inhabitants of the entire community were invited to participate. Overall prevalence assessed by real-time PCR and sequencing was 19.6% (95% CI 16-23.2%, n=91) in 465 stool samples provided by the study participants. Younger age groups showed a significantly higher prevalence of T. whipplei colonization ranging from 40.0% (95% CI 27.8-52.2) among the 0-4 year olds to 36.4% (95% CI 26.1-46.6) among children aged 5-10 years. Prevalence decreased in older age groups (p<0.001) from 12.6% (95% CI 5.8-19.4%; 11-20 years) to 9.7% (95% CI 5.7-13.6) among those older than 20. Risk factor analysis revealed young age, male sex, and number of people sharing a bed as factors associated with an increased risk for T. whipplei carriage. These results demonstrate that T. whipplei carriage is highly prevalent in this part of Africa. The high prevalence in early life and the analysis of risk factors suggest that transmission may peak during childhood facilitated through close person-to-person contacts.

Detection of Tropheryma whipplei in stool samples by one commercial and two in‐house real‐time PCR assays

“…In rural Senegal, the prevalence in healthy individuals reaches 31% . Colonization rates reach up to 40% for children in Gabon and of up to 63% within a sub‐group of children in South‐East Asian Laos . While children <4 years of age were more frequently colonized in Africa , such colonization was preferentially observed in older children in Laos .…”

“…Precarious hygiene conditions have been presumed to be responsible for high colonization rates in resource‐limited tropical countries , with transmission via the fecal‐oral route . Transmissions to European travelers returning from the tropics have been documented and a potential association of T. whipplei detection with tropical sprue has been suspected .…”

Tropheryma whippleias a Cause of Epidemic Fever, Senegal, 2010–2012

“…However, T. whipplei is in fact a common bacterium associated with various conditions, such as acute infections (pneumonia and gastroenteritis) and chronic infections (classic Whipple disease and other infections without digestive involvement, including endocarditis and encephalitis) (10)(11)(12)(13)(14)(15)(16)(17)(18)(19). T. whipplei can also be carried in human feces and, less commonly, in the saliva (20)(21)(22)(23); carriage prevalence varies by the age and exposure of the population and by geographic area (21)(22)(23)(24)(25)(26)(27)(28)(29)(30).…”

Co-circulation of Plasmodium and Bacterial DNAs in Blood of Febrile and Afebrile Children from Urban and Rural Areas in Gabon

“…A recent study conducted in Gabon, but in an area other than those studied here, reported its high prevalence in stool specimens, and revealed that young age, male sex, and the number of people sharing a bed were factors associated with an increased risk for carriage of T. whipplei. 35 The studies, which are summarized in Table 4, show that the prevalence of bacteremias varies by area and country. Furthermore, the inclusion of rural populations, which are usually more exposed to microorganisms than those in urban areas, is one of the causes for the increased rate of bacteremias in some studies.…”