Whipple's disease and Tropheryma whipplei infections: from bench to bedside

Boumaza, Asma; Azzouz, Eya Ben; Arrindell, Jeffrey; Lépidi, Hubert; Mezouar, Soraya; Desnues, Benoît

doi:10.1016/s1473-3099(22)00128-1

Cited by 24 publications

(16 citation statements)

References 117 publications

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“…Interestingly, we also detected Tropheryma whipplei in one patient, commonly known as the causative organism of Whipple’s disease, a rare and potentially fatal multisystem disorder [ 72 ]. Studies have found varying prevalences of chronic asymptomatic carriage in different populations [ 73 , 74 ].…”

Section: Discussionmentioning

confidence: 99%

Is Autologous Fecal Microbiota Transfer after Exclusive Enteral Nutrition in Pediatric Crohn’s Disease Patients Rational and Feasible? Data from a Feasibility Test

Hoelz¹,

Heetmeyer²,

Tsakmaklis

et al. 2023

Nutrients

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Background: Exclusive enteral nutrition (EEN) is a highly effective therapy for remission induction in pediatric Crohn’s disease (CD), but relapse rates after return to a regular diet are high. Autologous fecal microbiota transfer (FMT) using stool collected during EEN-induced clinical remission might represent a novel approach to maintaining the benefits of EEN. Methods: Pediatric CD patients provided fecal material at home, which was shipped at 4 °C to an FMT laboratory for FMT capsule generation and extensive pathogen safety screening. The microbial community composition of samples taken before and after shipment and after encapsulation was characterized using 16S rRNA amplicon sequencing. Results: Seven pediatric patients provided fecal material for nine test runs after at least three weeks of nutritional therapy. FMT capsules were successfully generated in 6/8 deliveries, but stool weight and consistency varied widely. Transport and processing of fecal material into FMT capsules did not fundamentally change microbial composition, but microbial richness was <30 genera in 3/9 samples. Stool safety screening was positive for potential pathogens or drug resistance genes in 8/9 test runs. Conclusions: A high pathogen burden, low-diversity microbiota, and practical deficiencies of EEN-conditioned fecal material might render autologous capsule-FMT an unsuitable approach as maintenance therapy for pediatric CD patients.

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Section: Discussionmentioning

confidence: 99%

Is Autologous Fecal Microbiota Transfer after Exclusive Enteral Nutrition in Pediatric Crohn’s Disease Patients Rational and Feasible? Data from a Feasibility Test

Hoelz¹,

Heetmeyer²,

Tsakmaklis

et al. 2023

Nutrients

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“…Nevertheless, a male predominance is clearly reported, with 85% of the cases being men, mainly European, with an average age of 57.1 years ( McGee et al., 2018 ). Asymptomatic carriage is widely reported in healthy subjects compared to immunodeficient patients, in whom the bacterium may be pathological ( 15 ). A recent preliminary study showed that immunocompromised children constituted a reservoir for T. whipplei with 77% suffering from acute lymphocytic leukemia ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

A Massive Number of Extracellular Tropheryma whipplei in Infective Endocarditis: A Case Report and Literature Review

et al. 2022

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Whipple’s disease (WD) is a chronic multisystemic infection caused by Tropheryma whipplei. If this bacterium presents an intracellular localization, associated with rare diseases and without pathognomonic signs, it is often subject to a misunderstanding of its physiopathology, often a misdiagnosis or simply an oversight. Here, we report the case of a patient treated for presumed rheumatoid arthritis. Recently, this patient presented to the hospital with infectious endocarditis. After surgery and histological analysis, we discovered the presence of T. whipplei. Electron microscopy allowed us to discover an atypical bacterial organization with a very large number of bacteria present in the extracellular medium in vegetation and valvular tissue. This atypical presentation we report here might be explained by the anti-inflammatory treatment administrated for our patient’s initial diagnosis of rheumatoid arthritis.

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“…Whipple’s disease manifests clinically in predisposed individuals with abnormalities in the cell-mediated immunity 11. The widespread use of immunosuppressive therapy, especially TNFI, has caused an increase in reported cases of Whipple’s disease 1. A case control review of 19 publications described 41 patients who developed Whipple’s disease while receiving TNFI 12.…”

Section: Discussionmentioning

confidence: 99%

“…Whipple’s disease is caused by infection with the bacterium Tropheryma whipplei which is abundant in the environment. An asymptomatic carrier state is seen in 1% of the population but in certain patients with abnormalities in the cell-mediated immunity the infection is activated leading to Whipple’s disease 1. The increased use of tumour necrosis factor inhibitor (TNFI) therapy and other immunosuppressive therapies including steroids, methotrexate and thiopurines has led to the unmasking of asymptomatic infection leading to Whipple’s disease 2…”

Section: Introductionmentioning

confidence: 99%

Whipple’s disease unmasked by TNF inhibitor therapy for treatment of seronegative rheumatoid arthritis

et al. 2022

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Whipple's disease and Tropheryma whipplei infections: from bench to bedside

Cited by 24 publications

References 117 publications

Is Autologous Fecal Microbiota Transfer after Exclusive Enteral Nutrition in Pediatric Crohn’s Disease Patients Rational and Feasible? Data from a Feasibility Test

Is Autologous Fecal Microbiota Transfer after Exclusive Enteral Nutrition in Pediatric Crohn’s Disease Patients Rational and Feasible? Data from a Feasibility Test

A Massive Number of Extracellular Tropheryma whipplei in Infective Endocarditis: A Case Report and Literature Review

Whipple’s disease unmasked by TNF inhibitor therapy for treatment of seronegative rheumatoid arthritis

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