<i>Tropheryma whipplei</i>Genotypes 1 and 3, Central Europe

Wetzstein, Nils; Fénollar, Florence; Buffet, Sylvain; Moos, Verena; Schneider, Thomas; Raoult, Didier

doi:10.3201/eid1902.120709

Cited by 14 publications

(11 citation statements)

References 10 publications

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“…The heterogeneity of the T. whipplei genome was subsequently confirmed by a study of 34 children with gastroenteritis in Marseille, France, as 12 new genotypes were detected (15). While there were many distinct genotypes observed, infections with type 1 and 3 are predominant, as they account for 35% of all European samples and caused small clonal outbreaks in central Europe (15,54,99). In a recent study, 72 different genotypes of T. whipplei have been found among strains from 191 positive samples from patients from central Europe (99).…”

Section: Bacterial Factorsmentioning

confidence: 85%

“…While there were many distinct genotypes observed, infections with type 1 and 3 are predominant, as they account for 35% of all European samples and caused small clonal outbreaks in central Europe (15,54,99). In a recent study, 72 different genotypes of T. whipplei have been found among strains from 191 positive samples from patients from central Europe (99). Studies in Senegal confirmed the heterogeneity of the genome, as 30 new genotypes of T. whipplei were found (17).…”

Section: Bacterial Factorsmentioning

confidence: 95%

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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: Bacterial Factorsmentioning

confidence: 85%

Section: Bacterial Factorsmentioning

confidence: 95%

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

et al. 2017

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“…Interestingly, this points to a high host dependency and to the parasitic nature of T. whipplei . Many genotypes have been described with different geographical distribution . The bacterium is an environmental antigen as it occurs in the soil, drinking water and the sewage .…”

Section: Microbiology and Pathogenesis Of T Whipplei Infection/wdmentioning

confidence: 99%

Systematic review: Whipple's disease (Tropheryma whipplei infection) and its unmasking by tumour necrosis factor inhibitors

Marth

2015

Aliment Pharmacol Ther

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Summary Background The classical form of Whipple's disease (WD), clinically characterised by arthropathy, diarrhoea and weight loss, is rare. Recently, other more frequent forms of Tropheryma whipplei infection have been recognised. The clinical spectrum includes an acute, self‐limiting disease in children, localised forms affecting cardiac valves or the central nervous system without intestinal symptoms, and asymptomatic carriage of T. whipplei which is found in around 4% of Europeans. Genomic analysis has shown that T. whipplei represents a host‐dependent or opportunistic bacterium. It has been reported that the clinical course of T. whipplei infection may be influenced by medical immunosuppression. Aim To identify associations between immunomodulatory treatment and the clinical course of T. whipplei infection. Methods A PubMed literature search was performed and 19 studies reporting on immunosuppression, particularly therapy with tumour necrosis factor inhibitors (TNFI) prior to the diagnosis in 41 patients with Whipple?s disease, were evaluated. Results As arthritis may precede the diagnosis of WD by many years, a relevant percentage (up to 50% in some reports) of patients are treated with immunomodulatory drugs or with TNFI. Many publications report on a complicated Whipple?s disease course or T. whipplei endocarditis following medical immunosuppression, particularly after TNFI. Standard diagnostic tests such as periodic acid–Schiff stain used to diagnose Whipple?s disease often fail in patients who are pre‐treated by TNFI. Conclusions In cases of doubt, Whipple?s disease should be excluded before therapy with TNFI. The fact that immunosuppressive therapy contributes to the progression of T. whipplei infection expands our pathogenetic view of this clinical entity.

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“…Sewers seem to form an ecological niche as high concentrations of T. whipplei DNA have been detected [ 14 ]. By now, 72 genotypes are known which were identified through four highly variable gene sequences via PCR analyses [ 19 , 20 ]. The most common genotypes in Europe are 1 and 3 which lead to smaller endemic infections in the form of gastroenteritis [ 19 ].…”

Section: Microbiology and Pathogenesismentioning

confidence: 99%

“…By now, 72 genotypes are known which were identified through four highly variable gene sequences via PCR analyses [ 19 , 20 ]. The most common genotypes in Europe are 1 and 3 which lead to smaller endemic infections in the form of gastroenteritis [ 19 ]. The wall of the bacterium consists of mucopolysaccharides, which are stained red by the PAS (periodic acid-Schiff) reaction.…”

Section: Microbiology and Pathogenesismentioning

confidence: 99%

Whipple's Disease

Obst¹,

Arnim²,

Malfertheiner³

2014

Visc Med

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Background: Whipple's disease (WD) is rarely the cause of a malabsorption syndrome. The disease is a chronic infection of the intestinal mucosa with the bacterium Tropheryma whipplei, which leads to a lymphostasis with an impaired absorption of the nutrition. Due to its low incidence (1:1,000,000) and the non-specific early symptoms, the disease is often diagnosed only after many years. Methods: Based on a selective literature review and the clinical experience of the authors, the current knowledge of WD regarding pathogenesis, clinical presentation, diagnosis, and therapy are presented in this paper. Results: Recent studies suggest that a host-specific dysfunction of the intestinal macrophages is responsible for the chronic infection with T. whipplei. Prior to patients reporting symptoms of a malabsorption syndrome (chronic diarrhea/steatorhea, weight loss), they often suffer from non-specific symptoms (polyarthralgia, fever, fatigue) for many years. Misdiagnoses such as seronegative polyarthritis are frequent. Furthermore, neurological, cardiac, ocular, or dermatological symptoms may occur. The standard method concerning diagnosis is the detection of PAS(periodic acid-Schiff)-positive macrophages in the affected tissues. Immunohistochemical staining and PCR(polymerase chain reaction)-based genetic analysis increase the sensitivity and specificity of conventional detection methods. Endoscopically, the intestinal mucosa appears edematous with lymphangiectasias, enlarged villi, and white-yellowish ring-like structures. The German treatment recommendations include a two-week intravenous induction therapy with ceftriaxone, which is followed by a three-month oral maintenance therapy with trimethoprim/sulfamethoxazole. Conclusion: WD is rarely responsible for a malabsorption syndrome. However, if WD is not recognized, the disease can be lethal. New diagnostic methods and prospectively approved therapeutic concepts allow an adequate treatment of the patient. Due to the host-specific susceptibility to T. whipplei, a lifelong follow-up is necessary.

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Tropheryma whippleiGenotypes 1 and 3, Central Europe

Cited by 14 publications

References 10 publications

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

Systematic review: Whipple's disease (Tropheryma whipplei infection) and its unmasking by tumour necrosis factor inhibitors

Whipple's Disease

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