Tropheryma whipplei prevalence strongly suggests human transmission in homeless shelters

Abstract

Tropheryma whipplei prevalence strongly suggests human transmission in homeless sheltersThe spectrum of infections due to Tropheryma whipplei is wide. [1][2][3] The bacterium is detected with variable prevalence in stool and saliva specimens from healthy individuals. [4][5][6] In France, the prevalence of T. whipplei in stool samples from the general adult population is estimated to be approximately 3%. 4 We report the prevalence of T. whipplei carriage in stool and saliva specimens from homeless people living in the two shelters in Marseille, France. 7 Specimens were obtained during the winter season (February 2010 and 2011), when homeless people congregate in the same shelter. T. whipplei PCR, genotyping, and the handling of DNA were performed as previously described. 4,6,8,9 Overall, the prevalence of T. whipplei in stool samples was 12.9% (21/162 samples included) and in saliva was 3.7% (8/238 samples included). All positive individuals were men (age 20-74 years, mean 46.21 years, and age 31-74 years, mean 55 years, for stool samples and saliva, respectively). The mean duration of homelessness was 50 AE 108.35 months and 45.71 AE 70.7 months, for stool samples and saliva, respectively. No difference was observed with regard to place of birth. The prevalence of T. whipplei in stool samples was higher in 2010 than in 2011 (19.5% vs. 10.7% (8/41 vs. 13/121); p = 0.2) and in shelter 2 than in shelter 1 in 2010 (24.1% vs. 8.3% (7/29 vs. 1/12); p = 0.2). The prevalence of T. whipplei in saliva was significantly higher in 2010 than in 2011 (7.7% vs. 1.3% (6/78 vs. 2/160); p = 0.009).

Looking for Tropheryma whipplei Source and Reservoir in Rural Senegal

“…Several findings support the theory of inter-human transmission of T. whipplei, 14 including the existence of specific T. whipplei clones, not only among the population of Dielmo and Ndiop 10 but also among children during episodes of T. whipplei gastroenteritis, 4 among relatives of people positive for T. whipplei, 12 and among homeless people sleeping in the same shelter. Having analyzed the questionnaires, the only factor significantly associated with the circulation of T. whipplei within households is a lack of toilets in households.…”

“…Thus, the relationship of the lack of toilet facilities to the detection of T. whipplei in households supports the theory of human-to-human transmission of the bacterium, with the inter-human transmission being from human feces through hand transmission. 14 Tropheryma whipplei is known to be viable in human fecal and saliva samples, suggesting that the bacterium might be transmitted through both fecal-oral and oro-oral routes. 26,27 Depending on the living conditions of the subjects, either method of transmission may be prevalent.…”

“…9,13 Another recent risk factor that has been identified is the living conditions of homeless people in shelters. 14 The poor hygiene and unsanitary conditions associated with shelters may explain the high prevalence of T. whipplei among homeless people. However, in Europe, the diseases linked to exposure to human feces (such as typhoid fever and shigellosis) are for the most part no longer a health problem.…”

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

“…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).…”

“…Also, in a study in Senegal, only three different epidemic genotypes were found (17). Finally, outbreaks of two different genotypes in homeless shelters in France have been reported (54). These three studies all suggest that clonal outbreaks of T. whipplei do occur.…”