Periodic acid-schiff-negative granulomatous lymphadenopathy in patient with whipple's disease

Tropheryma whipplei is a bacterium associated with Whipple’s disease, which commonly manifests as weight loss, arthralgia, and diarrhea. The most frequently involved organs comprise the heart and eyes, in addition to the central nervous system. Few studies have explored the relationship between T. whipplei and pneumonia. Herein, we report three patients with interstitial lung disease (ILD) of unknown cause, whose bronchoalveolar lavage fluid (BALF) were evaluated via Nanopore sequencing. In our in-house BALF Nanopore platform, human DNA was removed with saponin, to improve the reads ratio of microorganisms/host. T. whipplei was the sole or most abundant pathogen in all the patients, comprising 1,385, 826, and 285 reads. The positive result was confirmed via quantitative polymerase chain reaction (PCR) with two pairs of primers (cycle threshold value: 33.26/36.29; 31.68/32.01; 28.82/28.80) and Sanger sequencing. To our knowledge, this is the first report of T. whipplei detection using Nanopore-based sequencing. The turnaround time was approximately 6–8 h in clinical laboratories, including less than 1 h for analysis. In conclusion, the results of this study confirm that Nanopore sequencing can rapidly detect rare pathogens, to improve clinical diagnosis. In addition, diagnosis of Whipple’s disease should be combined other laboratory findings, such as periodic acid-Schiff (PAS) staining, and considered a possibility in middle-aged men presenting with ILD and a clinical history of unexplained arthralgia and/or fever.

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Whipple’s Disease: Our Own Experience and Review of the Literature

Gastroenterology Research and Practice ◽

10.1155/2013/478349 ◽

2013 ◽

Vol 2013 ◽

pp. 1-10 ◽

Cited By ~ 8

Author(s):

Jan Bureš ◽

Marcela Kopáčová ◽

Tomáš Douda ◽

Jolana Bártová ◽

Jan Tomš ◽

...

Keyword(s):

Systemic Disease ◽

Periodic Acid ◽

Favourable Outcome ◽

Penicillin G ◽

Low Grade ◽

Whipple’S Disease ◽

Review Of The Literature ◽

Intestinal Histology ◽

Whipple's Disease ◽

Periodic Acid Schiff

Whipple’s disease is a chronic infectious systemic disease caused by the bacteriumTropheryma whipplei. Nondeforming arthritis is frequently an initial complaint. Gastrointestinal and general symptoms include marked diarrhoea (with serious malabsorption), abdominal pain, prominent weight loss, and low-grade fever. Possible neurologic symptoms (up to 20%) might be associated with worse prognosis. Diagnosis is based on the clinical picture and small intestinal histology revealing foamy macrophages containing periodic-acid-Schiff- (PAS-) positive material. Long-term (up to one year) antibiotic therapy provides a favourable outcome in the vast majority of cases. This paper provides review of the literature and an analysis of our 5 patients recorded within a 20-year period at a tertiary gastroenterology centre. Patients were treated using i.v. penicillin G or amoxicillin-clavulanic acid + i.v. gentamicin for two weeks, followed by p.o. doxycycline (100 mg per day) plus p.o. salazopyrine (3 g per day) for 1 year. Full remission was achieved in all our patients.

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Whipple’s disease scleral nodules: a novel presentation in 2 consecutive patients

BMC Ophthalmology ◽

10.1186/s12886-020-01695-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Waleed K. Alsarhani ◽

Muhannad I. Alkhalifah ◽

Hind M. Alkatan ◽

Afaf L. Alsolami ◽

Azza M. Y. Maktabi ◽

...

Keyword(s):

Systemic Disease ◽

Periodic Acid ◽

Surgical Excision ◽

Successful Outcome ◽

Whipple’S Disease ◽

Whipple's Disease ◽

Periodic Acid Schiff ◽

Systemic Involvement ◽

Male Farmer ◽

Systemic Symptoms

Abstract Background Whipple’s disease (WD) is a rare, chronic, infection caused by gram-positive filamentous aerobic actinobacterium Tropheryma whipplei occurs classically in the gastrointestinal tract and shows histopathologically foamy macrophages with typical numerous PAS-positive, non-acid fast particles. Ocular WD in the form of uveitis may occur in the absence of systemic disease but has not been reported to present with scleral manifestation. We describe for the first time to the best of our knowledge 2 cases of scleral nodules with typical histopathological morphology of WD and without systemic involvement. Case presentation The first was a 53-year old diabetic male farmer who presented with 2 nontender right eye scleral nodules for 3 months, had a negative systemic workup, and surgical excision showed Periodic acid Schiff (PAS)-positive eosinophilic structures inside macrophages. Grocott’s methenamine silver (GMS) stain and acid-fast bacilli (AFB) stain of the tissue itself were negative. The second case was a 60-year old male who presented with an asymptomatic superior scleral nodule for 4 months, which showed similar appearance and negative GMS and AFB stains. Conclusion WD should be included in the differential diagnosis of scleral nodules even in the absence of systemic symptoms. Surgical excision without systemic treatment resulted in successful outcome without recurrence.

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Role of enteroscopy in the diagnosis of whipple’s disease

Acta Gastro Enterologica Belgica ◽

10.51821/84.4.020 ◽

2021 ◽

Vol 84 (4) ◽

pp. 665-667

Author(s):

M Mascarenhas Saraiva ◽

T Ribeiro ◽

T Costa Pereira ◽

P Andrade ◽

H Cardoso ◽

...

Keyword(s):

Periodic Acid ◽

Clinical Manifestations ◽

Systemic Infection ◽

Whipple’S Disease ◽

Upper Endoscopy ◽

Whipple's Disease ◽

Periodic Acid Schiff ◽

Abdominal Symptoms ◽

Duodenal Biopsies

Whipple’s disease is a rare chronic systemic infection caused by Tropheryma whipplei. The widespread infection by this rod is responsible for the protean clinical manifestations of the disease, although its classical form is notable for the prevalence of abdominal symptoms such as chronic diarrhea and abdominal pain. Whitish-yellow patches, suggestive of lymphangiectasia, are typically observed in the duodenum during upper endoscopy. The diagnosis of this condition is supported by the identification in duodenal biopsies of Periodic acid-Schiff staining within lamina propria macrophages. Nevertheless, a significant portion of patients do not have lesions within the range of conventional upper endoscopy. Therefore, other endoscopic procedures such as video capsule endoscopy and enteroscopy may be useful to detect more distal lesions. The authors describe a case where the combined used of both techniques allowed the unmasking of this disease.

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Whipple’s Disease Affecting Ileal Peyer’s Patches: The First Case Report

Case Reports in Pathology ◽

10.1155/2019/1509745 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Sabah Sid’Amar ◽

Giacomo Puppa

Keyword(s):

Lymphoid Tissue ◽

Diagnostic Yield ◽

Clinical Investigation ◽

Periodic Acid ◽

Disease Diagnosis ◽

Peyer's Patches ◽

Peyer’S Patches ◽

Whipple’S Disease ◽

Whipple's Disease ◽

First Case

Whipple’s disease is a rare chronic systemic bacterial infectious disease which can affect multiple organs, with a wide clinical spectrum encompassing many symptoms presenting in various forms and combinations. In the cases where the gastrointestinal tract is implicated, the more frequent localizations involve the small bowel, especially the duodenum. A case of a 67-year-old man who underwent clinical investigation after presenting with a progressive weight loss and showing a hypercapting right paracoeliac adenopathy at PET-CT scan is reported herein. A gastroscopy and a colonoscopy were done. The biopsies of the endoscopically normal ileal mucosa encompassed some submucosal Peyer’s patches. Histological examination of this lymphoid tissue revealed several foamy macrophages which turned out positive on periodic acid-Schiff special staining. Polymerase chain reaction of the microdissected lymph follicles allowed for confirming Whipple’s disease diagnosis. A targeted antibiotic treatment administrated to the patient led to a rapid clinical improvement. This finding of a previously unreported localization of infected macrophages in Whipple’s disease suggests that sampling the organized mucosal-submucosal lymphoid tissue may increase the diagnostic yield in endoscopic biopsies.

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Whipple's Disease and “Tropheryma whippelii”

Clinical Microbiology Reviews ◽

10.1128/cmr.14.3.561-583.2001 ◽

2001 ◽

Vol 14 (3) ◽

pp. 561-583 ◽

Cited By ~ 157

Author(s):

Fabrizio Dutly ◽

Martin Altwegg

Keyword(s):

Bacterial Species ◽

Periodic Acid ◽

Clinical Manifestations ◽

The Body ◽

Rrna Gene ◽

Low Grade ◽

Whipple’S Disease ◽

Major Step ◽

Whipple's Disease ◽

Initial Symptoms

SUMMARY Whipple's disease is a rare bacterial infection that may involve any organ system in the body. It occurs primarily in Caucasian males older than 40 years. The gastrointestinal tract is the most frequently involved organ, with manifestations such as abdominal pain, malabsorption syndrome with diarrhea, and weight loss. Other signs include low-grade fever, lymphadenopathy, skin hyperpigmentation, endocarditis, pleuritis, seronegative arthritis, uveitis, spondylodiscitis, and neurological manifestations, and these signs may occur in the absence of gastrointestinal manifestations. Due to the wide variability of manifestations, clinical diagnosis is very difficult and is often made only years or even decades after the initial symptoms have appeared. Trimethoprim-sulfamethoxazole for at least 1 year is usually considered adequate to eradicate the infection. The microbiological diagnosis of this insidious disease is rendered difficult by the virtual lack of culture and serodiagnostic methods. It is usually based on the demonstration of periodic acid-Schiff-positive particles in infected tissues and/or the presence of bacteria with an unusual trilaminar cell wall ultrastructure by electron microscopy. Recently, the Whipple bacteria have been characterized at the molecular level by amplification of their 16S rRNA gene(s). Phylogenetic analysis of these sequences revealed a new bacterial species related to the actinomycete branch which was named “Tropheryma whippelli.” Based on its unique 16S ribosomal DNA (rDNA) sequence, species-specific primers were selected for the detection of the organism in clinical specimens by PCR. This technique is currently used as one of the standard methods for establishing the diagnosis of Whipple's disease. Specific and broad-spectrum PCR amplifications mainly but not exclusively from extraintestinal specimens have significantly improved diagnosis, being more sensitive than histopathologic analysis. However, “T. whippelii” DNA has also been found in persons without clinical and histological evidence of Whipple's disease. It is unclear whether these patients are true asymptomatic carriers or whether differences in virulence exist among strains of “T. whippelii” that might account for the variable clinical manifestations. So far, six different “T. whippelii” subtypes have been found by analysis of their 16S-23S rDNA spacer region. Further studies of the pathogen “T. whippelii” as well as the host immune response are needed to fully understand this fascinating disease. The recent cultivation of the organisms is a promising major step in this direction.

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Ultrastructure of the Parotid Gland of the Nine-Banded Armadillo

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100080626 ◽

1977 ◽

Vol 35 ◽

pp. 640-641

Author(s):

J. R. Ruby

Keyword(s):

Endoplasmic Reticulum ◽

Parotid Gland ◽

Periodic Acid ◽

Acinar Cells ◽

Duct System ◽

Parotid Glands ◽

Dasypus Novemcinctus ◽

Anterior Portion ◽

Periodic Acid Schiff ◽

Thin Sections

Parotid glands were obtained from five adult (four male and one female) armadillos (Dasypus novemcinctus) which were perfusion-fixed. The glands were located in a position similar to that of most mammals. They extended interiorly to the anterior portion of the submandibular gland.In the light microscope, it was noted that the acini were relatively small and stained strongly positive with the periodic acid-Schiff (PAS) and alcian blue techniques, confirming the earlier results of Shackleford (1). Based on these qualities and other structural criteria, these cells have been classified as seromucous (2). The duct system was well developed. There were numerous intercalated ducts and intralobular striated ducts. The striated duct cells contained large amounts of PAS-positive substance.Thin sections revealed that the acinar cells were pyramidal in shape and contained a basally placed, slightly flattened nucleus (Fig. 1). The rough endoplasmic reticulum was also at the base of the cell.

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Scanning Electron Microscopy of Human Jejunum in Whipple's Disease

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100079279 ◽

1977 ◽

Vol 35 ◽

pp. 354-355

Author(s):

John H. L. Watson ◽

C. N. Sun

Keyword(s):

Electron Microscopy ◽

Scanning Electron Microscopy ◽

Basement Membrane ◽

Lamina Propria ◽

Brush Border ◽

Whipple’S Disease ◽

Whipple's Disease ◽

Biopsy Specimens ◽

Brush Borders ◽

Scanning Electron

That the etiology of Whipple's disease could be bacterial was first suggested from electron micrographs in 1960. Evidence for binary fission of the bacteria, their phagocytosis by histiocytes in the lamina propria, their occurrence between and within the cells of the epithelium and on the brush border of the lumen were reported later. Scanning electron microscopy has been applied by us in an attempt to confirm the earlier observations by the new technique and to describe the bacterium further. Both transmission and scanning electron microscopy have been used concurrently to study the same biopsy specimens, and transmission observations have been used to confirm those made by scanning.The locations of the brush borders, the columnar epithelial cells, the basement membrane and the lamina propria beneath it were each easily identified by scanning electron microscopy. The lamina propria was completely filled with the wiener-shaped bacteria, Fig. 1.

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