Prevalence of Tropheryma whipplei DNA in Patients with Various Gastrointestinal Diseases and in Healthy Controls

Abstract

We conclude that the asymptomatic carrier state of T. whipplei indeed exists and that it is much more frequent than the rare Whipple's disease. The higher prevalence of T. whipplei DNA in the saliva of patients with reflux syndrome suggests that the stomach might be the habitat of the organism.

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

“…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).…”

“…Asymptomatic carriers of T. whipplei represent a large reservoir from which other humans might be colonized. The bacterium has been found in various samples, including saliva, urine, blood, cardiac valve, myocardium, synovial fluid, skeletal muscle, stool, skin, lymph node, lung, bronchoalveolar fluid, stomach, spleen, liver, larynx, small bowel, colon, maxillary sinus, cerebrospinal fluid, brain, and aqueous humor samples (18,42,43,45,(49)(50)(51).…”

“…Recent data suggest that the presence of T. whipplei in fecal samples from asymptomatic individuals varies between 1.5 to 4% (14,18,(41)(42)(43) in the general population of Europe but that it can be up to 12 to 25% in specific populations like sewage workers, HIV-infected, and the homeless (43,52,53). Also, patients with cirrhosis were found to have a high carriage rate of 12.5% (52).…”

Whipple's Disease: a Macrophage Disease

“…However, it is now known that the disease is often multisystemic, including possible cardiac and central nervous system involvement, and has clinical manifestations that may be varied and nonspecific (Table 1). T. whipplei has been detected in 4% of patients with various gastrointestinal diseases and in 7% of presumably healthy control subjects (2). T. whipplei DNA has also been detected in 40% of subgingival and gingival sulcus samples from healthy individuals (124).…”

Use of Genome Selected Repeated Sequences Increases the Sensitivity of PCR Detection of Tropheryma whipplei

“…We hypothesize that in these cases, the number of T. whipplei bacteria present is very low; thus, DNA is only detected by a more sensitive tool. The PCR specificity for the diagnosis of Whipple's disease has been questioned due to the presence of false-positive results, but study results are discrepant (2,6,7,11,19). Here, T. whipplei DNA was never amplified in our control group despite the fact that we had enhanced the sensitivity of our assay.…”