Whipple Endocarditis without Overt Gastrointestinal Disease: Report of Four Cases

Gubler, Jacques; Kuster, Marcel; Dutly, Fabrizio; Bannwart, Fridolin; Krause, Martín; Vögelin, Hans Peter; Garzoli, G.; Altwegg, Martin

doi:10.7326/0003-4819-131-2-199907200-00007

Cited by 101 publications

(72 citation statements)

References 19 publications

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“…However, the clinical sensitivity, i.e., the sensitivity with regard to the detection of patients with Whipple's disease, is only 63% but still significantly higher than that of histopathology (4,17,19,23), with a clinical sensitivity of only 12.5% in our small series. This confirms that PCR from duodenal biopsies and stool specimens is significantly more sensitive than histopathology and that a number of patients with Whipple's disease show no gastrointestinal evidence (clinical or laboratory) whatsoever for the presence of this disease (9,11,20).…”

Section: Discussionsupporting

confidence: 68%

“…These stool samples were taken simultaneously with gastric aspirates and biopsies. Patients were divided into three different groups (Tables 1 and 2) as follows: I, patients with confirmed Whipple's disease and typical manifestations (endocarditis [11]), intestinal manifestations, spondylodiscitis [1]); II, patients with suspicion of Whipple's disease; and III, persons from the prospective study mentioned above without clinical signs of Whipple's disease. Stool samples were kept at Ϫ20°C until analysis.…”

Section: Methodsmentioning

confidence: 99%

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Detection of Tropheryma whipplei DNA in Feces by PCR Using a Target Capture Method

2002

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Whipple's disease is a rare multisystemic bacterial infection with variable clinical manifestations. For decades, the laboratory diagnosis was based on the demonstration of periodic acid Schiff-positive inclusions in macrophages of gastrointestinal biopsies. PCR has improved the diagnosis of Whipple's disease due to its increased sensitivity compared to histopathological analysis. To avoid invasive procedures for taking specimens, we have investigated the possibility of detecting Tropheryma whipplei DNA in feces rather than in biopsies or gastric aspirate of patients with and without Whipple's disease. Total bacterial DNA was isolated from stool specimens using Qiagen columns followed by a T. whipplei-specific hybridization step with a biotinylated capture probe and streptavidin-coated magnetic particles. The captured DNA was then amplified using the same seminested PCR targeting the 16S rRNA gene of the organism that had been applied to other specimens without capturing. For five of eight patients with Whipple's disease, duodenal biopsies and stool samples were PCR positive, whereas for the three other patients, both specimens were PCR negative. Of 84 patients without Whipple's disease, 75 tested negative in the duodenal biopsy and in the stool sample. For four, both specimens were positive. Five patients tested positive in the stool sample but not in the biopsy. However, for three of these five patients, the gastric aspirate had been PCR positive, indicating that the stool PCR result was true rather than false positive. Compared to PCR from duodenal biopsies, stool PCR has a sensitivity of 100% and a specificity of 97.3%. Additionally, 15 PCR-positive and 22 PCR-negative stool samples were extracted using the Invisorb Spin Stool DNA kit. The simplified stool extraction showed 93.3% sensitivity and 95.5% specificity compared to the target capture method. We conclude that PCR with stool specimens with either extraction method is a sensitive and specific diagnostic tool for the detection of T. whipplei DNA and one not requiring invasive sampling procedures.

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Section: Discussionsupporting

confidence: 68%

Section: Methodsmentioning

confidence: 99%

Detection of Tropheryma whipplei DNA in Feces by PCR Using a Target Capture Method

2002

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“…However, gastrointestinal symptoms are minimal or absent for approximately 15% of patients (5,7,8,24,28). Neurologic Whipple's disease without digestive symptoms has been reported (12,23) as well as cardiac involvement (4,7,11,13,30). In 1991, Wilson et al used broad-range primers to amplify bacterial 16S rDNA directly from infected tissue and then determined that this bacterium belongs to the high-GϩC-content, gram-positive bacteria among the class Actinomycetes (36).…”

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confidence: 99%

Culture of Tropheryma whipplei from Human Samples: a 3-Year Experience (1999 to 2002)

et al. 2003

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The culture of Tropheryma whipplei, the bacterium responsible for Whipple's disease, has been established only recently. Our objective is to describe, based on our experience, the culture of T. whipplei in HEL cells detected by immunofluorescence staining. Over 3 years, we received 18 samples for T. whipplei culture from 15 patients with Whipple's disease. Ten duodenal biopsy specimens from 10 patients with digestive symptoms were available. Five cardiac valves and three blood samples from five patients with endocarditis were also available. We correlated the results of culture with the type of sample and the culture procedure. Seven isolates were obtained, and three were subsequently established for more than 4 passages. The mean delay for the primary detection was 30 days. The bacterium was isolated more frequently from sterile specimens (5 of 8) than from duodenal biopsy specimens (2 of 10), but the difference (P ‫؍‬ 0.14) was not significant. Decontamination of digestive samples containing colistin, amphotericin B, and cephalotin or ciprofloxacin did not impair the isolation of T. whipplei. The use of vancomycin precludes the primary isolation (7 of 12 versus 0 of 6; P ‫؍‬ 0.08) and the establishment of T. whipplei (3 of 12 versus 0 of 6; P ‫؍‬ 0.5). Omitting samples cultured with vancomycin, the establishment of the strain was significantly higher when antibiotics were prescribed for no more than 7 days (3 of 4 versus 0 of 8; P ‫؍‬ 0.03). Our results demonstrate that samples must be collected within 1 week of an antibiotic regimen's initiation for the successful establishment of the bacterium.

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“…Consequent malabsorption associated with Whipple's disease is believed to be secondary to the disruption of normal villous function due to infiltration of the lamina propria of the small bowel with these foamy macrophages. Patients with arthralgia had been found to have the organism in their synovial tissues [14]. The organisms had been detected in the heart valves of patients with cardiac Whipple's disease [15] and in the CNS of patients with neurological disease.…”

Section: Pathology and Immunologymentioning

confidence: 99%

Whipple’s Disease: A Case Report and Review of Literature

Elkholy¹,

Khaled²,

Aziz³

et al. 2017

MOJCR

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Whipple's disease is a rare systemic disease. It is caused by a gram-positive infectious bacillus called Tropheryma whipplei (T. whipplei). The common presenting feature is malabsorption, but it can also affect multiple organs as heart, central nervous system (CNS), joints, skin, lungs and vascular system. Presentation can be highly variable but mainly the patients are complaining of weight loss, diarrhea, joint pain and arthritis, about 15% of patients do not develop these classic symptoms. Endoscopic picture usually shows pale yellow shaggy mucosa with erythematous eroded patches in the duodenum extending up to the jejunum. Definitive diagnosis is made mainly by endoscopic duodenal biopsies that show characteristic foamy macrophages in the lamina propria containing non-acid fast gram positive bacilli that stain red with Periodic acid-Schiff (PAS) stain. Immunohistochemical staining for antibodies against T. whipplei had been used to detect the organism in a variety of tissues. Polymerase chain reaction (PCR) of T. whipplei is considered a confirmatory test. We present a case of classic Whipple's disease with review of literature for better understanding of the presentation, methods of diagnosis and treatment of the disease.

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Whipple Endocarditis without Overt Gastrointestinal Disease: Report of Four Cases

Abstract: In patients with culture-negative endocarditis, the absence of clinical, microscopic, or microbiological evidence of gastrointestinal disease did not rule out T. whippelii.

Cited by 101 publications

References 19 publications

Detection of Tropheryma whipplei DNA in Feces by PCR Using a Target Capture Method

Detection of Tropheryma whipplei DNA in Feces by PCR Using a Target Capture Method

Culture of Tropheryma whipplei from Human Samples: a 3-Year Experience (1999 to 2002)

Whipple’s Disease: A Case Report and Review of Literature

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