Synovial fluid polymerase chain reaction as an aid to the diagnosis of central nervous system Whipple's disease

Delanty, Norman; Georgescu, Liviu; Lynch, Tim; Paget, Stephen; Stübgen, Joerg‐Patrick

doi:10.1002/1531-8249(199901)45:1<137::aid-art25>3.0.co;2-g

Cited by 14 publications

(4 citation statements)

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“…Since its first use more than a decade ago, PCR testing has become a more common non‐invasive, sensitive, specific, and rapid test for the diagnosis of Whipple's disease (11, 14, 21). T. whipplei PCR assays have been used to detect the bacilli in blood and cardiac tissues (17, 22, 23), synovial fluid (24, 25), cerebrospinal fluid (26–30), vitreous fluid (9, 31), and other specimens (32) to confirm the clinical diagnosis of Whipple's endocarditis (17, 22, 33), arthropathy (24), neurologic illness (26–30), and chorioretinitis and uveitis (9, 31), respectively. In this regard, we also suggest that this non‐invasive PCR test be utilized to monitor therapeutic response (8), as illustrated by our case whose PCR tests were negative at 1 and 3 months following antibiotic therapy.…”

Section: Discussionmentioning

confidence: 99%

Chorioretinitis and vitreitis due to Tropheryma whipplei after transplantation: case report and review

Razonable

Pulido

Deziel³

et al. 2008

Transplant Infectious Dis

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Whipple's disease is a very rare chronic multisystemic bacterial disease characterized by diarrhea, malabsorption, fever, and polyarthritis. Ocular manifestations occur very rarely. Previous reports have suggested that the use of immunosuppressive drugs appears to accelerate or exacerbate the clinical course of Whipple's disease; however, the illness has yet to be reported in the setting of transplantation. Herein, we describe what we believe is the first reported case of Whipple's disease after transplantation. The patient is a 51-year-old woman who developed progressive visual floaters and blurring of vision 30 years after living-related kidney transplantation for an autosomal-dominant polycystic kidney disease. Her allograft was functioning well on maintenance immunosuppressive therapy with azathioprine and prednisone when she developed visual abnormalities. Transient weight loss, gastrointestinal symptoms, and migratory polyarthralgia predated the onset of ocular disease by several years. The diagnosis of Whipple's bilateral vitreitis and chorioretinitis was confirmed by polymerase chain reaction analysis demonstrating Tropheryma whipplei nucleic acid in vitreous fluid and peripheral blood sample as well as by demonstration of the bacilli by cytopathology. Intraocular vancomycin, intravenous ceftriaxone, and prolonged course of oral trimethoprim-sulfamethoxazole therapy led to clinical improvement and recovery of visual acuity.

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Section: Discussionmentioning

confidence: 99%

Chorioretinitis and vitreitis due to Tropheryma whipplei after transplantation: case report and review

Razonable

Pulido

Deziel³

et al. 2008

Transplant Infectious Dis

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“…Using Tropheryma whippelii-specific PCR primers, it is possible to identify RNA from the organism in various biopsied human tissues, including the heart, vitreous fluid, peripheral blood cells, pleural effusion, synovial fluid, and CSF [8,35]. PCR has high sensitivity and specificity for Whipple disease in cases with biopsy-proven disease.…”

Section: Diagnosismentioning

confidence: 99%

Whipple disease

Louis

2003

Curr Neurol Neurosci Rep

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Whipple disease is a rare disease caused by infection with the bacterium Tropheryma whippelii. Humans are the only known host for the infection. The signs of systemic infection include gastrointestinal problems, weight loss, and arthritis. Signs of central nervous system infection include cognitive changes, supranuclear gaze palsy, altered level of consciousness, and movement disorders. The diagnosis is based on clinical findings as well as microscopic examination of biopsy specimens and, more recently, polymerase chain reaction (PCR) analysis, which has high sensitivity and specificity. Although the organism historically has been difficult to culture, several recent attempts have been successful. Antibiotic treatment is recommended for 1 year while monitoring the clinical signs and cerebrospinal fluid PCR results.

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“…The detection of T. whipplei DNA in lymph nodes allows the correct diagnosis of Whipple's disease [62]. Several reports have shown that T. whipplei detection by PCR analysis is also a useful diagnostic tool for synovial tissue and fluid allowing an early diagnosis of the disease in patients with nonspecific articular symptoms [34,61,[74][75][76][77]. Broad-spectrum PCR also resulted in the unexpected detection of T. whipplei DNA in the lumbar biopsy of a young female patient with spondylodiscitis [55].…”

Section: Other Samplesmentioning

confidence: 99%

Molecular techniques in Whipple’s disease

Fénollar

Raoult

2001

Expert Review of Molecular Diagnostics

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Whipple's disease is a systemic infection, caused by the bacterium Tropheryma whipplei, with protean clinical manifestations characterized by fever, weight loss, diarrhea, polyarthritis, skin hyperpigmentation and adenopathy. For a long time, due to the inability to culture the causative organism, diagnosis was based on histologic examination of infected tissues, usually duodenal biopsies, which revealed diastase-resistant periodic acid-Schiff-positive staining. Now, PCR of various tissues or fluid is emerging as a way to diagnose Whipple's disease. However, the presence of T. whipplei DNA in saliva, gastric juice or duodenal biopsies of healthy individuals has led to questions regarding the specificity of the molecular techniques involved. After a series of failures, stable culture was achieved in 2000. Subsequently, the generation of rabbit polyclonal antibodies has led to the detection of the bacterium in tissues by immunohistology. However, culture and immunohistology are very recent techniques and are not yet widely used. Propagation of the bacterium will lead to extensive molecular knowledge of T. whipplei, which will help in the diagnosis and understanding of the epidemiology and pathogenicity of Whipple's disease.

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Synovial fluid polymerase chain reaction as an aid to the diagnosis of central nervous system Whipple's disease

Cited by 14 publications

References 4 publications

Chorioretinitis and vitreitis due to Tropheryma whipplei after transplantation: case report and review

Chorioretinitis and vitreitis due to Tropheryma whipplei after transplantation: case report and review

Whipple disease

Molecular techniques in Whipple’s disease

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