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
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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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    • "Whipple disease (WD) is a rare infectious disease caused by the Gram-positive bacillus Tropheryma whipplei that most commonly affects the gastrointestinal system with symptoms of chronic diarrhea and malabsorption but can also affect many other organ systems (Dobbins and Ruffin 1967; La Scola et al. 2001; Fenollar et al. 2007). The central nervous system (CNS) is involved in up to 40% of cases and can have widely variable neurologic manifestations (Sieracki et al. 1960; Halperin et al. 1982; Fleming et al. 1988; Louis et al. 1996; Verhagen et al. 1996, 1997; Durand et al. 1997; Anderson 2000; La Scola et al. 2001; Gerard et al. 2002; Scheld 2003; Marth 2009). "
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    ABSTRACT: Whipple disease (WD) is usually a systemic infectious disease that can have central nervous system (CNS) involvement. WD confined to the CNS is extremely rare and difficult to diagnose, but can be fatal if not treated in a timely fashion. We present the case of a 42-year-old man with a subacute dementia accompanied by a movement disorder consisting of progressive supranuclear gaze palsy, myoclonus, and ataxia. Our patient lacked the typical magnetic resonance imaging (MRI) findings reported with isolated CNS WD and had a false-positive cerebrospinal fluid (CSF) 14-3-3 protein. The patient expired, and definitive diagnosis of isolated CNS WD was made by autopsy with characteristic macrophage accumulations found in the brain but not in the gastrointestinal tract. We examine the literature on isolated CNS WD and discuss how these previously unreported findings make a rare diagnosis even more challenging. The reported patient is the first in the literature with tissue diagnosis of isolated CNS WD in the setting of normal brain MRI and positive CSF 14-3-3 protein. Isolated CNS WD should be added to the list of considerations for a false-positive CSF 14-3-3 protein. Even in the absence of typical MRI lesions, a patient with subacute progressive dementia, supranuclear gaze palsy, and other various neurologic abnormalities should have the diagnosis of isolated CNS WD considered.
    Brain and Behavior 11/2012; 2(6):838-43. DOI:10.1002/brb3.97
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