Whipple's endocarditis

West, Douglas; Hutcheon, SD; Kain, Renate; Reid, T. M. S.; Walton, S.; Buchan, K

doi:10.1258/jrsm.98.8.362

Cited by 7 publications

(3 citation statements)

References 7 publications

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“…The published data reviewed here suggest that endocarditis due to T. whipplei occurs not infrequently without any of the classical features of Whipple’s disease. At least six out of 27 patients in the present series did not have any symptoms other than those attributable to endocarditis [26,27,29,31,33,42], and our four patients clinically had no gastrointestinal involvement, fitting the diagnosis of isolated T. whipplei endocarditis. In patient 4 of our series a systemic involvement could not be excluded; however, weight loss and night sweats were considered to be manifestations of his underlying cancer.…”

Section: Discussionsupporting

confidence: 55%

“…Our review of the literature encompasses the period up to June 2009 and adds another 27 cases resulting in at least 97 cases of endocarditis due to T. whipplei ; the additional reports include patients from the UK, the Czech Republic, Spain, Brazil, Denmark, the Antilles and Tunisia [6,24–43]. Patients 1, 3, 6, 11, 16 and 26 had no symptoms other than those attributable to endocarditis and, in four of them (patients 1, 3, 16 and 26), analyses of the intestinal biopsies were negative, leading to the diagnosis of isolated T. whipplei endocarditis (patient characteristics shown in Tables 3 and 4; for a detailed analysis, see Supporting Information, Data S2).…”

Section: Resultsmentioning

confidence: 99%

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Endocarditis due to Tropheryma whipplei: rapid detection, limited genetic diversity, and long-term clinical outcome in a local experience

Escher

Roth

Droz

et al. 2010

Clinical Microbiology and Infection

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The characteristic features of Whipple's disease include abdominal pain, diarrhoea, wasting, and arthralgias, with the causative agent, Tropheryma whipplei, being detected mainly in intestinal biopsies. PCR technology has led to the identification of T. whipplei in specimens from various other locations, including the central nervous system and the heart. T. whipplei is now recognized as one of the causes of culture-negative endocarditis, and endocarditis can be the only manifestation of the infection with T. whipplei. Although it is considered a rare disease, the true incidence of endocarditis due to T. whipplei is not clearly established. With the increasing use of molecular methods, it is likely that T. whipplei will be more frequently identified. Questions also remain about the genetic variability of T. whipplei strains, optimal diagnostic procedures and therapeutic options. In the present study, we provide clinical data on four new patients with documented endocarditis due to T. whipplei in the context of the available published literature. There was no clinical involvement of the gastrointestinal tract. Genetic analysis of the T. whipplei strains with DNA isolated from the excised heart valves revealed little to no genetic variability. In a selected case, we describe acridine orange staining for early detection of the disease, prompting early adaptation of the antibiotic therapy. We provide long-term follow-up data on the patients. In our hands, an initial 2-week course of intravenous antibiotics followed by cotrimoxazole for at least 1 year was a suitable treatment option for T. whipplei endocarditis.

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Section: Discussionsupporting

confidence: 55%

Section: Resultsmentioning

confidence: 99%

Endocarditis due to Tropheryma whipplei: rapid detection, limited genetic diversity, and long-term clinical outcome in a local experience

Escher

Roth

Droz

et al. 2010

Clinical Microbiology and Infection

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“…This form of endocarditis is an intracellular infection rather than a biofilm-like superficial cardiovalvular colonization with the bacterium. In most patients, there are no other manifestations of classic Whipple's disease (113,(149)(150)(151)(152), and clinical signs are similar to those of cardiac disease with negative blood cultures (113). In spite of the negative blood cultures, 80% of these patients displayed an increased C-reactive protein level, indicative of an infection and vegetations in 79% of cases (113).…”

Section: Localized Chronic Infectionsmentioning

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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