Prevalence of Asymptomatic<i>Tropheryma whipplei</i>Carriage among Humans and Nonhuman Primates

Fénollar, Florence; Trani, Michèle; Davoust, Bernard; Sallé, Bettina; Birg, Marie-Laure; Rolain, Jean‐Marc; Raoult, Didier

doi:10.1086/528693

Cited by 161 publications

(130 citation statements)

References 27 publications

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“…Microscopy of biopsy samples is a costly and invasive method and therefore not frequently used for screening purposes and usually performed only to confirm the diagnosis in the case of a serious suspicion of infection. Carriage of T. whipplei was first suggested by Dutly and Altwegg (37), and since then T. whipplei DNA has been detected in stool, saliva, and biopsy samples from asymptomatic individuals by using PCR (18,(41)(42)(43)(44)(45). Upon the initial encounter with T. whipplei, most carriers develop a protective immune response that prevents further spread of the bacterium through the body or eliminates the bacterium completely (46)(47)(48).…”

Section: Carriage Of Tropheryma Whippleimentioning

confidence: 99%

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: Carriage Of Tropheryma Whippleimentioning

confidence: 99%

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

et al. 2017

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“…We considered samples to be positive if both specific qPCRs were positive, i.e., the cycle number at the threshold level of log-based fluorescence (Ct) was lower than 40. To validate the test, we used positive and negative controls, as previously reported 9 ; for positive specimens, genotyping was attempted, as previously described. 19 Statistical analysis.…”

Section: The Studymentioning

confidence: 99%

“…8 The prevalence of T. whipplei carriage in stool and saliva specimens from healthy individuals depends predominantly on the geographic area, the occupation of the subjects, and their proximity to T. whipplei carriers. [9][10][11][12] In two Senegalese villages, the incidence of T. whipplei DNA in stool samples is~17.4% among the healthy adult population, reaching 75% among healthy children younger than 5 years of age. 10 Currently, two important, yet unsolved issues are the habitat of T. whipplei and its route of infectious transmission.…”

Section: Introductionmentioning

confidence: 99%

“…In Europe, the first risk factor that has been shown is occupational: the rate of infection among underground sewer workers suggests the danger of exposure to human feces. 9,13 Another recent risk factor that has been identified is the living conditions of homeless people in shelters. 14 The poor hygiene and unsanitary conditions associated with shelters may explain the high prevalence of T. whipplei among homeless people.…”

Section: Introductionmentioning

confidence: 99%

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Looking for Tropheryma whipplei Source and Reservoir in Rural Senegal

Keïta

Mediannikov²,

Ratmanov³

et al. 2013

The American Society of Tropical Medicine and Hygiene

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Abstract. Tropheryma whipplei, the bacterium linked to Whipple's disease, is involved in acute infections and asymptomatic carriage. In rural Senegal, the prevalence of T. whipplei is generally high but is not homogeneous throughout households in the same village. We studied environmental samples collected in two Senegalese villages and conducted the survey to investigate the difference between households. Overall, the comparison between five households with very high T. whipplei prevalence and three households without any registered cases showed that the only difference was the presence of toilets in the latter (1/5 versus 3/3; P = 0.01423). Among the 1,002 environmental specimens (including domestic and synanthropic animals and dust sampled in households) tested for T. whipplei DNA, only four specimens were slightly positive. Humans are currently the predominant identified reservoir and source of T. whipplei in these populations. Limited access to toilets and exposure to human feces facilitate the fecal-oral transmission of T. whipplei.

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“…Self-limiting asymptomatic or moderate infections with this agent are common (2,3) and result in a protective humoral and cellular immunity in most individuals (4,5). In contrast, subtle immune defects that occur only rarely seem to predispose for CWD: an HLA association (6) and immunological aberrations point at problems in the axis of antigen processing/presentation/T cell activation (4,(7)(8)(9)(10)(11)(12).…”

Section: Lassical Whipple's Disease (Cwd) Is a Chronic Multisystemimentioning

confidence: 99%

Role of Dendritic Cells in the Pathogenesis of Whipple's Disease

et al. 2015

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c Accumulation of Tropheryma whipplei-stuffed macrophages in the duodenum, impaired T. whipplei-specific Th1 responses, and weak secretion of interleukin-12 (IL-12) are hallmarks of classical Whipple's disease (CWD). This study addresses dendritic cell (DC) functionality during CWD. We documented composition, distribution, and functionality of DC ex vivo or after in vitro maturation by fluorescence-activated cell sorting (FACS) and by immunohistochemistry in situ. A decrease in peripheral DC of untreated CWD patients compared to healthy donors was due to reduced CD11c high myeloid DC (M-DC). Decreased maturation markers CD83, CD86, and CCR7, as well as low IL-12 production in response to stimulation, disclosed an immature M-DC phenotype. In vitro-generated monocyte-derived DC from CWD patients showed normal maturation and T cell-stimulatory capacity under proinflammatory conditions but produced less IL-12 and failed to activate T. whipplei-specific Th1 cells. In duodenal and lymphoid tissues, T. whipplei was found within immature DC-SIGN ؉ DC. DC and proliferating lymphocytes were reduced in lymph nodes of CWD patients compared to levels in controls. Our results indicate that dysfunctional IL-12 production by DC provides suboptimal conditions for priming of T. whipplei-specific T cells during CWD and that immature DC carrying T. whipplei contribute to the dissemination of the bacterium.

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Prevalence of AsymptomaticTropheryma whippleiCarriage among Humans and Nonhuman Primates

Abstract: Chronic asymptomatic carriage of T. whipplei occurs in humans. Bacterial loads are lower in asymptomatic carriers, and the prevalence of carriage increases with exposure to sewage.

Cited by 161 publications

References 27 publications

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

Looking for Tropheryma whipplei Source and Reservoir in Rural Senegal

Role of Dendritic Cells in the Pathogenesis of Whipple's Disease

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