BackgroundWhipple’s disease, a rare chronic infectious disorder caused by Tropheryma whipplei, may present with predominant joint manifestations mimicking rheumatoid arthritis (RA).MethodsA retrospective single-center cohort study of seven patients was performed. Clinical symptoms were assessed by review of medical charts and Whipple’s disease was diagnosed by periodic-acid-Schiff-stain and/or Tropheryma whipplei-specific polymerase-chain-reaction.ResultsMedian age at disease onset was 54 years, six patients were male. Median time to diagnosis was 5 years. All patients presented with polyarthritis with a predominantly symmetric pattern. Three had erosive arthritis. Affected joints were: wrists (5/7), metacarpophalangeal joints (MCPs) (5/7), knees (5/7), proximal interphalangeal joints (PIPs) (3/7), hips (2/7), elbow (2/7), shoulder (2/7). All patients had increased C-reactive-protein concentrations, while rheumatoid factor and anti-CCP-antibodies were absent, and were initially (mis)classified as RA-patients according to EULAR/ACR-criteria (median DAS28 4.3). Six patients received antirheumatic treatment consisting of prednisone with methotrexate and/or leflunomide, three were additionally treated with at least one biologic agent (abatacept, adalimumab, etanercept, rituximab, tocilizumab). Most patients showed insufficient treatment response. In all patients Tropheryma whipplei was detected in synovial fluid by polymerase-chain-reaction; in three patients the diagnosis of Whipple’s disease was further ascertained by periodic-acid-Schiff-staining. Gastrointestinal symptoms and other extra-articular manifestations were absent, mild or non-specific. Treatment was initiated with trimethoprin/sulfamethoxazole in five and doxycycline/hydroxychloroquine in two patients and had to be adapted in five patients. Finally, all patients had good treatment responses with improvement of arthritis and extra-articular manifestations.ConclusionWhipple’s disease is rare and can mimic rheumatoid arthritis. Especially patients with seronegative rheumatoid arthritis with a prolonged disease course and insufficient treatment response should be reevaluated for Whipple’s disease.

Depending on environmental factors fungal diseases of crops are often distributed heterogeneously in fields. Precision agriculture in plant protection implies a targeted fungicide application adjusted these field heterogeneities. Therefore an understanding of the spatial and temporal occurrence of pathogens is elementary. As shown in previous studies, remote sensing techniques can be used to detect and observe spectral anomalies in the field. In 2008, a sugar beet field site was observed at different growth stages of the crop using different remote sensing techniques. The experimental field site consisted of two treatments. One plot was sprayed with a fungicide to avoid fungal infections. In order to obtain sugar beet plants infected with foliar diseases the other plot was not sprayed. Remote sensing data were acquired from the high-resolution airborne hyperspectral imaging ROSIS in July 2008 at sugar beet growth stage 39 and from the HyMap sensor systems in August 2008 at sugar beet growth stage 45, respectively. Additionally hyperspectral signatures of diseased and non-diseased sugar beet plants were measured with a non-imaging hand held spectroradiometer at growth stage 49 in September. Ground truth data, in particular disease severity were collected at 50 sampling points in the field.Changes of reflection rates were related to disease severity increasing with time. Erysiphe betae causing powdery mildew was the most frequent leaf pathogen. A classification of healthy and diseased sugar beets in the field was possible by using hyperspectral vegetation indices calculated from canopy reflectance.

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