<i>Tropheryma whipplei</i> in Feces of Patients with Diarrhea in 3 Locations on Different Continents

Feurle, Gerhard E.; Moos, Verena; Landt, Olfert; Corcoran, Craig; Reischl, Udo; Maiwald, Matthias

doi:10.3201/eid2703.200182

Cited by 8 publications

(6 citation statements)

References 15 publications

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“…Similar to previous Korean studies conducted with saliva, T. whipplei was detected low in the stools of patients with diarrhea, with a prevalence of 1.4% [ 22 , 23 ]. A recent study investigating the stools of patients with diarrhea for T. whipplei in three locations on different continents reported that its prevalence may differ between continents [ 26 ]. The prevalence of T. whipplei was 17.5% in South Africa, 15% in Singapore, and 3.3% in Germany, all higher than in Korea [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…A recent study investigating the stools of patients with diarrhea for T. whipplei in three locations on different continents reported that its prevalence may differ between continents [ 26 ]. The prevalence of T. whipplei was 17.5% in South Africa, 15% in Singapore, and 3.3% in Germany, all higher than in Korea [ 26 ]. To date, Whipple’s disease has not been reported in Korea, and it has been reported very rarely in Japan [ 23 , 27 , 28 ]; it is in line with the low prevalence of T. whipplei found in our study.…”

Section: Discussionmentioning

confidence: 99%

“…In patients who took these antibiotics before sampling, the results for T. whipplei could be affected. Since the prevalence of T. whipplei varies from region to region, regional factors as well as antibiotics should be considered [15,17,18,21,[26][27][28]. Third, although the total number of samples was large, the follow-up RT-PCRs were performed on the small number of samples that were deemed positive by the initial RT-PCR.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and detection of Tropheryma whipplei in the stools of Korean patients with diarrhea using real-time PCRs

Yoon

Choi

Lim

et al. 2022

Ann Clin Microbiol Antimicrob

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Background The prevalence of Tropheryma whipplei varies depending on age, region, and underlying disease. We estimated the prevalence of T. whipplei in the stools of Korean patients with diarrhea using real-time PCR (RT-PCR) and compared three RT-PCR targets, rpoB, hsp65, and Dig15. Methods A total of 1404 nucleic acid samples extracted from the stools of Korean patients with diarrhea were tested using an initial RT-PCR targeting T. whipplei-specific regions of 16S–23S rRNA intergenic spacer. Subsequently, the samples positive for the initial RT-PCR were tested using the follow-up RT-PCRs targeting rpoB, hsp65, and Dig15 and analyzed by sequencing to confirm the presence of T. whipplei. We estimated the prevalence of T. whipplei and compared them according to gender and age. We also compared the performance of three targets in the follow-up RT-PCRs. Results T. whipplei was detected in 1.4% of all samples (20 of 1404), and there were no differences according to gender and age. In pediatric samples (≤ 19 years), T. whipplei was detected higher in children aged 6–19 than in those aged 1–5 (2.7% vs. 0.7%, P = 0.01). Sensitivities of the rpoB, hsp65, and Dig15 RT-PCR were 50.0%, 85.0%, and 95.0%, respectively; specificities were 100.0%, 100.0%, and 84.6%, respectively. Conclusions This is the first study that estimated the prevalence of T. whipplei in the stools of Korean patients with diarrhea. This study demonstrated the presence of T. whipplei in stools of Koreans, even though the bacterium was detected low. The RT-PCRs targeting hsp65 and Dig15 showed reliable performance, and a multiplex PCR including these targets is expected to be useful for T. whipplei detection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prevalence and detection of Tropheryma whipplei in the stools of Korean patients with diarrhea using real-time PCRs

Yoon

Choi

Lim

et al. 2022

Ann Clin Microbiol Antimicrob

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“…Our findings are also in line with a recent work from Ghana in which T. whipplei was found equally in symptomatic pediatric cases and controls [ 25 ]. Despite earlier research indicating that individuals might develop mild diarrhea when infected, Feurle et al concluded in their study of symptomatic patients from different origins that T. whipplei was associated with the presence of other stool pathogens, but that an independent causative role of this sole microbe in diarrhea appeared unlikely [ 26 , 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Intestinal Colonization with Tropheryma whipplei—Clinical and Immunological Implications for HIV Positive Adults in Ghana

et al. 2021

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Background: Recent studies demonstrated higher prevalence rates of Tropheryma whipplei (T. whipplei) in HIV positive than in HIV negative subjects. However, associations with the immune status in HIV positive participants were conflicting. Methods: For this cross-sectional study, stool samples of 906 HIV positive and 98 HIV negative individuals in Ghana were tested for T. whipplei. Additionally, sociodemographic parameters, clinical symptoms, medical drug intake, and laboratory parameters were assessed. Results: The prevalence of T. whipplei was 5.85% in HIV positive and 2.04% in HIV negative participants. Within the group of HIV positive participants, the prevalence reached 7.18% in patients without co-trimoxazole prophylaxis, 10.26% in subjects with ART intake, and 12.31% in obese participants. Frequencies of clinical symptoms were not found to be higher in HIV positive T. whipplei carriers compared to T. whipplei negative participants. Markers of immune activation were lower in patients colonized with T. whipplei. Multivariate regression models demonstrated an independent relationship of a high CD4+ T cell count, a low HIV-1 viral load, and an obese body weight with the presence of T. whipplei. Conclusions: Among HIV positive individuals, T. whipplei colonization was associated with a better immune status but not with clinical consequences. Our data suggest that the withdrawal of co-trimoxazole chemoprophylaxis among people living with HIV on stable cART regimen may inadvertently increase the propensity towards colonization with T. whipplei.

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“…Classic WD is rare, but its cause, T. whipplei , is an intestinal bacterium that is relatively commonly detected in the saliva and stools of healthy carriers [ 4 ]. The prevalence of T. whipplei has been reported to vary from 1.5% to as high as 48% depending on age, region, occupational exposure, and underlying disease [ 4 – 11 ]. In Europe, T. whipplei was detected at a prevalence of up to 4% in the stools of healthy carriers, but at a higher prevalence of 12–25% in the stools of sewer workers and patients with liver cirrhosis [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence estimation of Tropheryma whipplei in duodenal biopsy tissues of Koreans

Yoon,

Hong,

Hong

et al. 2024

Ann Clin Microbiol Antimicrob

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Whipple’s disease caused by Tropheryma whipplei is difficult to diagnose because of a broad spectrum of manifestations and non-specific clinical signs. In the current global era, the incidence of duodenal infection/inflammation caused by T. whipplei in Korea may has been underestimated. Here we estimated the prevalence of T. whipplei in duodenal biopsy tissues of Koreans using real-time PCRs (RT-PCRs). A total of 252 duodenal biopsy tissues were collected from Korean patients who underwent esophagogastroduodenoscopy and duodenal biopsy. DNA extracted from the duodenal biopsy tissues was analyzed using three RT-PCRs targeting T. whipplei-specific regions of the 16S–23S rRNA intergenic spacer, hsp65, and Dig15 in parallel. In the samples positive in RT-PCRs, direct sequencing was performed for each RT-PCR target. The prevalence of T. whipplei was estimated based on the RT-PCR and sequencing results. Among the analyzed samples, T. whipplei was not detected. The prevalence of T. whipplei in duodenal biopsy tissues of Koreans was estimated to be less than 0.4%. This is the first study to attempt to detect T. whipplei in duodenal biopsy tissues of Koreans and estimate its prevalence. Our findings infer that while T. whipplei carriers exist in Korea, the incidence of duodenal infection/inflammation caused by T. whipplei is extremely rare.

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Tropheryma whipplei in Feces of Patients with Diarrhea in 3 Locations on Different Continents

Cited by 8 publications

References 15 publications

Prevalence and detection of Tropheryma whipplei in the stools of Korean patients with diarrhea using real-time PCRs

Prevalence and detection of Tropheryma whipplei in the stools of Korean patients with diarrhea using real-time PCRs

Intestinal Colonization with Tropheryma whipplei—Clinical and Immunological Implications for HIV Positive Adults in Ghana

Prevalence estimation of Tropheryma whipplei in duodenal biopsy tissues of Koreans

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