Molecular techniques in Whipple’s disease

Fénollar, Florence; Raoult, Didier

doi:10.1586/14737159.1.3.299

Cited by 50 publications

(31 citation statements)

References 60 publications

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“…For most patients, the definite diagnosis is based on histological observation of T. whipplei bacilli in (proximal) small bowel biopsy specimens (10,73,(169)(170)(171). Most patients with classic Whipple's disease usually have large numbers of bacteria in their duodenal mucosa, but this seldom results in an inflamed appearance of the duodenum during endoscopy (10,73).…”

Section: Routine Diagnostic Methodsmentioning

confidence: 99%

“…Most patients with classic Whipple's disease usually have large numbers of bacteria in their duodenal mucosa, but this seldom results in an inflamed appearance of the duodenum during endoscopy (10,73). The mucosa of the duodenum frequently has dilated villi with ectatic lymph vessels and a pale yellow color (10,171,172). As the bacterium is not evenly distributed over the duodenum, several samples of the duodenum should be obtained in order to avoid sampling bias in patients who do carry the bacterium in their duodenum.…”

Section: Routine Diagnostic Methodsmentioning

confidence: 99%

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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: Routine Diagnostic Methodsmentioning

confidence: 99%

Section: Routine Diagnostic Methodsmentioning

confidence: 99%

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

et al. 2017

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“…For example, using the cell culture in shell vial, we have destroyed the myth that considered T. whipplei to be "uncultivable" (39). Since then, the isolation and establishment of this bacterium have led to new perspectives for the management and treatment of Whipple disease (1,12,30,31,33,34,42). Also, to start with, T. whipplei was considered to be a hypothetical intracellular bacterium (25).…”

Section: Discussionmentioning

confidence: 99%

Use of Shell-Vial Cell Culture Assay for Isolation of Bacteria from Clinical Specimens: 13 Years of Experience

et al. 2005

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The shell-vial culture assay is performed routinely in our laboratory. Recently we revisited our experience of using the shell-vial culture assay for the isolation of microorganisms from various clinical samples. Over a 13-year period, we have isolated 580 bacterial strains (5%) from 11,083 clinical samples tested. Over the same period, 285 isolates of rickettsiae, bartonellae, or Coxiella burnetii were cultured from a total of 7,102 samples tested. These isolates include 55 Rickettsia sp. isolates, 95 Coxiella burnetii isolates, and 135 Bartonella sp. isolates. Based on our experience with the growth of fastidious microorganisms, we have used a centrifugation shell-vial technique called JNSP, for "je ne sais pas" ("I don't know [what I am growing]") for the isolation of other microorganisms. A total of 173 isolates were cultured from the 3,861 clinical samples tested using the JNSP method. Of these, 40 isolates had not been grown before on usual axenic medium. These include 2 Staphylococcus aureus isolates, 7 isolates of Streptococcus sp. and related genera, 6 Mycobacterium sp. isolates, 1 Nocardia asteroides isolate, 1 Actinomyces sp. isolate, 1 Brucella melitensis isolate, 2 Francisella tularensis isolates, 1 Mycoplasma pneumoniae isolate, and 1 Legionella pneumophila isolate. Using this protocol, we have also cultured intracellular bacteria such as Chlamydia trachomatis and we have performed the first culture and establishment of Trophyrema whipplei. Applied in our laboratory, the shell-vial culture generally exhibits a low rate of success. However, in some cases, this technique allowed microbial diagnosis when classical agar procedure and PCR were negative.The spectrum of infectious diseases is wide and changing. The reliable diagnosis of infectious disease remains a difficult problem even for specialized laboratories. Isolation of new microorganisms will allow the description of clinical features of new diseases and the characterization of new pathogens, enabling genetic descriptions, physiological analyses, improvement of diagnostic tools, and antibiotic susceptibility testing for bacteria. Therefore, the isolation of infecting bacteria is not only a mean of diagnosis but also a basis for the evaluation of much needed improved diagnostic assays and a route to enhance understanding of the diversity and the epidemiology of infections (21). The successful isolation of fastidious microorganisms is often based on cell culture (21). The success of this technique is based on two critical points. First, the ratio of microorganisms to cells should be as high as possible (21). Second, centrifugation enhances the adhesion of intracellular microorganisms to the cells (52). In 1976, a centrifugation-cell microculture system, called the shell-vial assay, was first used for the diagnosis of viral disease due to cytomegalovirus and allowed early antigen detection (22). This diagnostic tool is becoming one of the most commonly used techniques in clinical virology laboratories since it reduces turnaround time (19).For a lo...

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“…Other forms of skin involvement are very rare and non-specific and include subcutaneous nodules, erythroderma, purpura, vasculitis, panniculitis, hyperkeratosis, erythematous and urticarial lesions, dermatomyositis, eczematous dermatitis and lichenoid lesions with sarcoid granulomas in dermis [41] . An intestinal and/or cutaneous biopsy is necessary for diagnosis because it can show PAS-positive inclusion corresponding to T. whippelii infection [42] .…”

Section: Whipple's Diseasementioning

confidence: 99%

Intestinal Malabsorption and Skin Diseases

Abenavoli

Proietti

Vonghia

et al. 2008

Dig Dis

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Several skin manifestations were described in patients affected by intestinal disorders. The development of skin diseases in these patients could be related to the impairment of intestinal absorption and motility, other than to immunological and hormonal changes. The growing evidence of the association between skin disorders and intestinal diseases suggests that the skin could be considered the ‘mirror of the gut’.

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Molecular techniques in Whipple’s disease

Cited by 50 publications

References 60 publications

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

Use of Shell-Vial Cell Culture Assay for Isolation of Bacteria from Clinical Specimens: 13 Years of Experience

Intestinal Malabsorption and Skin Diseases

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