Article

Whipple's Disease

Unité des Rickettsies, IFR 48, Centre National de la Recherche Scientifique UMR 6020, and Université de la Méditerranée, Faculté de Médecine, Marseille, France.
New England Journal of Medicine (Impact Factor: 54.42). 02/2007; 356(1):55-66. DOI: 10.1056/NEJMra062477
Source: PubMed

ABSTRACT In 2000, Tropheryma whipplei was finally identified as the cause of Whipple's disease, a chronic condition with protean manifestations that was first described in 1907. This review discusses the epidemiology, pathogenesis, diagnosis, and treatment of this rare and elusive chronic disease.

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    • ". Tropheryma whipplei is the causative bacterium of Whipple's disease a well-known chronic infectious disease which represents only one rare clinical manifestation of T. whipplei [7]. Recently, T. whipplei has been associated with gastroenteritis in French children presenting high bacterial load of T. whipplei in stool samples by PCR, and IgM against T. whipplei in serum by Western blott [8]. "
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    ABSTRACT: Background Tropheryma whipplei was recently associated with gastroenteritis in children. We hypothesize that T. whipplei may be a contributing microbe in traveller’s diarrhea. Method The presence of T. whipplei was investigated by PCR on rectal swab samples of Hajj pilgrims before and after traveling to the Kingdom of Saudi Arabia (KSA). Additionally a rectal swab was performed at the time of diarrhea for some pilgrims. Results A total of 129 pilgrims underwent rectal swab samples before departure and on return. All pilgrims were negative for T. whipplei before travel. One pilgrim (0.8%) was positive on return but did not reported diarrhea. A total of 30 pilgrims (23.3%) experienced diarrhea during the stay in the KSA. Nine pilgrims with diarrhea underwent the additional rectal swab during their diarrhea episode, two of whom were positive for T. whipplei. Conclusions This work suggest that T. whipplei may be associated with adult traveller’s diarrhea, by finding T. whipplei DNA individuals negative before and after the episode of diarrhea. Further study addressing this issue in larger cohorts of Hajj pilgrims with systematic sampling at the time of diarrheal episode may help to understand the potential role of T. whipplei in traveler’s diarrhea.
    Travel Medicine and Infectious Disease 09/2014; 12(5). DOI:10.1016/j.tmaid.2014.04.003 · 1.54 Impact Factor
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    • "Diarrhea in travelers to Senegal may affect up to 46% of individuals [4]. Tropheryma whipplei is the causative bacterium of Whipple's disease a chronic infectious disease [5]. Up to now, T. whipplei was considered a rare bacterium that caused an uncommon disease. "
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    ABSTRACT: Background Tropheryma whipplei was recently associated with acute infections as gastroenteritis in children. We hypothesize that T. whipplei may be a contributing microbe in traveler's diarrhea. Method The presence of T. whipplei was investigated by using a specific PCR on stool samples of travelers to Senegal before and after traveling, independently of the occurrence of diarrhea. Results A total of 59 travelers returned both stool samples before and after travel and 16 (27%) experienced diarrhea during travel. Fifty-three patients (89.8%) were negative for T. whipplei before and after travel. Two patients (3.4%) were negative before and positive after travel. Two patients (3.4%) were positive before travel and negative after travel. Finally, two patients (3.4%) were positive before and after travel. There were no carriage differences of T. whipplei, visiting Senegal or staying in France. We found no significant association of T. whipplei carriage and travel-associated diarrhea but this may have been impacted by the use of doxycycline. Conclusions This is the first report of T. whipplei carriage acquired during travel to tropical area. Further study addressing this issue in larger cohorts of travelers to Senegal, including individuals visiting friends and relatives in their country of origin and the protective role of doxycycline malaria chemoprophylaxis may help to understand the potential contribution of T. whipplei to travelers' diarrhea.
    Travel Medicine and Infectious Disease 05/2014; 12(3). DOI:10.1016/j.tmaid.2014.01.009 · 1.54 Impact Factor
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    • "George Hoyt Whipple described Whipple's disease in 1907 where he named the disease as ‘intestinal lipodystrophy’ (9). However, the ability to identify and confirm the causal organism by genomic sequencing with 16S ribosomal RNA (rRNA) was accomplished in 1992 (9). Molecular amplification of the 16S rRNA of Trophyerma Whipplei by PCR and cell culture of the organism (10) greatly improved our knowledge of Whipple's disease (11). It has made tremendous improvements in enabling the clinicians to make the diagnosis in patients who do not have gastrointestinal symptoms (12). "
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    ABSTRACT: Whipple's disease is a systemic infectious disease caused by the bacteria Tropheryma whipplei. The most common clinical manifestations of Whipple's disease are weight loss (92%), hypoalbuminemia and steatorrhea (91%, respectively), diarrhea (72%), arthralgia (67%), and abdominal pain (55%). Neurological signs and symptoms from dementia to oculomasticatory myorhythmia or oculofacioskeletal myorhythmia (pathognomonic of Whipple's disease), lymphadenopathy, and fatigue can also be present. Pancytopenia is a rare and less recognized clinical feature in Whipple's disease patients. We are describing a case where a middle-aged Caucasian male diagnosed with Whipple's disease was found to have pancytopenia. Etiology of pancytopenia is postulated to be due to the invasion of bone marrow by T. whipplei. It is important to recognize that bone marrow involvement by the Whipple bacillus is not uncommon. In the presence of lymphadenopathy and pancytopenia, clinicians should think of Whipple's disease as a differential diagnosis apart from lymphoma or other non-specific granulomatous reticuloendothelial disorders.
    04/2014; 4(2). DOI:10.3402/jchimp.v4.23482
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