Tropheryma whipplei Endocarditis: Case Presentation and Review of the Literature

Abstract

Whipple’s disease is a rare infective condition, classically presenting with gastrointestinal manifestations. It is increasingly recognized as an important cause of culture-negative endocarditis. We present a case of Whipple’s endocarditis presenting with heart failure. A literature review identified 44 publications documenting 169 patients with Whipple’s endocarditis. The average age was 57.1 years. There is a clear sex predominance, with 85% of cases being male. Presenting symptoms were primarily articular involvement (52%) and heart failure (41%). In the majority of cases, the diagnosis was made on examination of valvular tissue. Preexisting valvular abnormalities were reported in 21%. The aortic valve was most commonly involved, and multiple valves were involved in 64% and 23% of cases, respectively. Antibiotic therapy was widely varied and included a ceftriaxone, trimethoprim, and sulfamethoxazole combination. The average follow-up was 20 months, and mortality was approximately 24%. Physician awareness is paramount in the diagnosis and management of this rare condition.

Tropheryma whipplei—A rare and diagnostically challenging cause of culture-negative endocarditis

“…Although isolated Whipple's endocarditis without systemic involvement has been reported in the literature [6][7][8], this disease entity is rare. A recent literature review by McGee et al identified 44 publications totaling 169 patients with Whipple's endocarditis [9]. While the incidence of classic Whipple's disease is estimated to be between 1 and 6 new cases per 10,000,000 persons per year worldwide [5], the incidence of isolated Whipple's endocarditis is unknown.…”

Tropheryma whipplei endocarditis: An uncommon infection with potentially fatal consequences

“…Notably, the prevalence was 26% among sewer workers and 37% among relatives of healthy carriers 2 . A recent literature review by McGee et al 3 reported male predominance (85%) in prevalence rates of TW infection. Interestingly, 52% of patients reported arthralgia (dissimilar to our patient's presentation), and 41% of the patients presented with heart failure, as was observed in our case.…”

“…Interestingly, 52% of patients reported arthralgia (dissimilar to our patient's presentation), and 41% of the patients presented with heart failure, as was observed in our case. A delay in diagnosis since the appearance of the first nonspecific symptoms was approximately 21 months, and the reported mortality rate was 24% 3 …”

Tropheryma whippleiEndocarditis

“…Comorbidities or other predisposing risk factors have been not uniformly reported in the literature [118]. Previous valvular affectation has been documented in 21% of the diagnosed cases, while prosthetic valve replacement previously to the event seems not an important condition (<5% of the available series).…”

“…Asthenia and malaise lasting more than six months were notified by the 41.2% of the patients in one series [70]. Other signs such as weight loss or gastrointestinal symptoms have been observed in 25% and 21% of the reported patients [118]. In addition, central nervous system manifestations (i.e., emboli) have been detected in 16% of patients.…”