Is the bacterium Tropheryma whipplei cause of the disease in a subgroup of patients with presumed sarcoidosis?

2012 ◽  
Vol 50 (05) ◽  
Author(s):  
E Dulic-Lakovic ◽  
M Hubner ◽  
C Müller ◽  
W Pokieser ◽  
M Dulic ◽  
...  
Keyword(s):  
Praxis ◽  
2002 ◽  
Vol 91 (41) ◽  
pp. 1691-1698
Author(s):  
Dancygier ◽  
Scharnke

Der Morbus Whipple ist eine seltene, ohne antibiotische Therapie tödlich verlaufende infektiöse Systemerkrankung durch das ubiquitär vorkommende, grampositive Bakterium Tropheryma whipplei. Der Erreger kann lichtoptisch, elektronenmikroskopisch und mittels PCR in betroffenen Geweben und Körperflüssigkeiten nachgewiesen werden. Betroffen sind vor allem Männer. Die meisten Patienten klagen über Gewichtsverlust, Diarrhoen, Abdominalschmerzen und Arthralgien. In 10–40% der Fälle ist auch das Zentralnervensystem, oft asymptomatisch, mitbeteiligt. Der Nachweis PAS-positiver Makrophagen in der Lamina propria des Dünndarms ist typisch aber nicht pathognomonisch für den Morbus Whipple. Der Erregernachweis sollte heute auch mittels PCR angestrebt werden. Die Behandlung mit liquorgängigen Antibiotika erfolgt meist als Sequenztherapie über mindestens ein Jahr, um Rezidive zu vermeiden. Vor Abschluss der Therapie ist der Nachweis der Erregerfreiheit im Darm und vermutlich auch im Liquor zu fordern.


2013 ◽  
Vol 33 (04) ◽  
pp. 229-233
Author(s):  
G. E. Feurle

ZusammenfassungMorbus Whipple wird durch das Bakterium Tropheryma whipplei verursacht. Die häufigsten Manifestationen sind Arthritis und Diarrhö, jeweils bei etwa 75 Prozent der Betroffenen. Im Labor findet sich in der Regel die Konstellation einer chronischen Entzündung. Zur Diagnostik werden die histologische Färbung mit PAS und die PCR für T. whipplei verwendet. Bei Biopsien aus der Schleimhaut des Gastrointestinaltraktes kann es bei luminaler Kolonisierung mit T. whipplei zu falsch positiven Ergebnissen der PCR kommen, weswegen hier auf eine histologische Untersuchung nicht verzichtet werden kann. Bei Punktaten und Biopsien aus Gelenken steht die PCR diagnostisch an erster Stelle. Keinen Konsens gibt es über Art und Dauer der antibiotischen Behandlung. Den besten Evidenzgrad hat die intravenöse Therapie mit Ceftriaxon gefolgt von oralem Cotrimoxazol. Ein orales Therapieschema mit Doxycyclin, Chloroquin und bei Fällen mit ZNS-Beteiligung zusätzlich Cotrimoxazol ist bislang nicht prospektiv getestet worden. Schwerwiegende Komplikationen wie das Immunrekonstitutionssyndrom werden besonders bei Patienten beobachtet, die immunsuppressiv vorbehandelt worden sind.


2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Binghua Zhu ◽  
Jing Tang ◽  
Rong Fang ◽  
Xuejie Fei ◽  
Qing Wang ◽  
...  

Abstract Background We diagnosed a clinical case of pulmonary infection involving Mycobacterium tuberculosis and Tropheryma whipplei in a patient with acute respiratory distress syndrome. The diagnosis was assisted by metagenomic next-generation sequencing of bronchoalveolar lavage fluid. Case presentation A 44-year-old Han Chinese inmate was transferred to the emergency department because of dry cough, chest tightness, and shortness of breath. The patient’s body temperature rose to 39.3 °C following empirical cephalosporin treatment for 1 week. The blood CD4+/CD8+ ratio was 0.7, suggesting immunodeficiency. Routine microbiological tests were performed, and tuberculosis interferon gamma release assays were positive. Mycobacterium tuberculosis polymerase chain reaction was also positive. Chest computed tomography scan revealed miliary nodules and ground-glass opacifications, which were in accordance with tuberculosis. To fully examine the etiology, we performed routine laboratory tests and metagenomic sequencing, the results of which indicated the presence of Mycobacterium tuberculosis and Tropheryma whipplei. We administered anti-tuberculosis regimen in combination with trimethoprim/sulfamethoxazole. The patient recovered, with chest computed tomography scan showing absorption of lesions. Conclusions Compared with traditional diagnostic methods such as culture and serology, metagenomic next-generation sequencing has the advantage of detecting a wide array of microorganisms in a single test and therefore can be used for clinical diagnosis of rare pathogens and microbial coinfections. It is particularly useful for immunocompromised patients as they are more prone to infection by opportunistic microorganisms.


2017 ◽  
Vol 85 (8) ◽  
Author(s):  
Lucia Trotta ◽  
Kathleen Weigt ◽  
Katina Schinnerling ◽  
Anika Geelhaar-Karsch ◽  
Gerrit Oelkers ◽  
...  

ABSTRACT Classical Whipple's disease (CWD) is characterized by the lack of specific Th1 response toward Tropheryma whipplei in genetically predisposed individuals. The cofactor GrpE of heat shock protein 70 (Hsp70) from T. whipplei was previously identified as a B-cell antigen. We tested the capacity of Hsp70 and GrpE to elicit specific proinflammatory T-cell responses. Peripheral mononuclear cells from CWD patients and healthy donors were stimulated with T. whipplei lysate or recombinant GrpE or Hsp70 before levels of CD40L, CD69, perforin, granzyme B, CD107a, and gamma interferon (IFN-γ) were determined in T cells by flow cytometry. Upon stimulation with total bacterial lysate or recombinant GrpE or Hsp70 of T. whipplei, the proportions of activated effector CD4+ T cells, determined as CD40L+ IFN-γ+, were significantly lower in patients with CWD than in healthy controls; CD8+ T cells of untreated CWD patients revealed an enhanced activation toward unspecific stimulation and T. whipplei-specific degranulation, although CD69+ IFN-γ+ CD8+ T cells were reduced upon stimulation with T. whipplei lysate and recombinant T. whipplei-derived proteins. Hsp70 and its cofactor GrpE are immunogenic in healthy individuals, eliciting effective responses against T. whipplei to control bacterial spreading. The lack of specific T-cell responses against these T. whipplei-derived proteins may contribute to the pathogenesis of CWD.


2015 ◽  
Vol 33 (2) ◽  
pp. 190-199 ◽  
Author(s):  
Thomas Marth

Background: The actinobacterium Tropheryma whipplei was detected 20 years ago by molecular techniques, and following its culture has been characterized as the cause of a systemic infection known as Whipple's disease (WD). T. whipplei occurs in the environment, is prevalent only in humans, is believed to be transmitted via oral routes and to be host dependent. Key Messages: The classical form of T. whipplei infection, i.e. classical WD (CWD), is rare. It is well defined as slowly progressing chronic infection with arthralgia, diarrhea and weight loss, mostly in middle-aged men. However, current research revealed a much broader spectrum of clinical features associated with T. whipplei infection. Thus, T. whipplei may cause acute and transient infections (observed primarily in children) and the bacterium, which is found in soil and water, occurs in asymptomatic carriers as well as in CWD patients in clinical remission. In addition, T. whipplei affects isolated and localized body compartments such as heart valves or the central nervous system. Subtle immune defects and HLA associations have been described. New findings indicate that the progression of asymptomatic T. whipplei infection to clinical WD may be associated with medical immunosuppression and with immunomodulatory conditions. This explains that there is a discrepancy between the widespread occurrence of T. whipplei and the rareness of WD, and that T. whipplei infection triggered by immunosuppression presents with protean clinical manifestations. Conclusions: This review highlights recent findings and the clinical spectrum of infection with T. whipplei and WD, focusing specifically on the role of host immunity and immunosuppression. Current concepts of the pathogenesis, diagnosis and therapy are discussed.


2010 ◽  
Vol 1 (4) ◽  
pp. e34-e34 ◽  
Author(s):  
L Gorvel ◽  
K Al Moussawi ◽  
E Ghigo ◽  
C Capo ◽  
J-L Mege ◽  
...  

Author(s):  
Alain García-Olea Jurado ◽  
Garazi Ramírez-Escudero Ugalde ◽  
Nora García Ibarrondo ◽  
Mireia de la Peña Trigueros ◽  
Lara Ruiz Gómez

2013 ◽  
Vol 41 (6) ◽  
pp. 592-594 ◽  
Author(s):  
Florence Fenollar ◽  
Jean-Christophe Lagier ◽  
Jean-Marc Rolain ◽  
Marie Célard ◽  
Olivier Bouchot ◽  
...  
Keyword(s):  

Author(s):  
Elian Massoud ◽  
Justin Watson ◽  
Amy Fiedler

Whipple’s endocarditis is a rare culture-negative endocarditis caused by Tropheryma whipplei, an intracellular gram-positive organism. Here, we present a case of a 60-year-old male who presented with transient ischemic attack and was found to have an aortic valve mass. Following successful excision, histopathologic assessment of the lesion was consistent with calcified amorphous aortic tumor, a rare non-neoplastic hamartomatous mass of the heart. However, 16s rRNA and 18s rRNA sequencing detected Tropheryma whipplei, and the diagnosis of Whipple’s endocarditis was made.


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