Whipple's disease and Tropheryma whipplei

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Specific diagnosisThe specific diagnosis includes : Immunohistochemistry Genomic amplification by PCR Culture The immunohistochemistry with polyclonal rabbit antibodies specifically directed against the bacterium could be performed on different samples (small-bowel, cardiac valve, brain, adenopathy), as body fluids (articular fluid, aqueous humor) and blood. This technique should be retrospectively performed on formalin-fixed samples. Positive immunohistochemistry of a duodenal biopsy. (x 100). -References : -Diagnosis of Whipple disease by immunohistochemical analysis: a sensitive and specific method for the detection of T. whipplei in paraffin-embedded tissue. Baisden et al. Am J Clin Pathol 2002: 118, 742-8. -T. whipplei circulating in blood monocytes. Raoult et al. N Engl J Med 2001: 345, 548. -Immunohistological detection of T. whipplei in lymph nodes. Lepidi et al. Am J Med 2002:118, 742-8. -Immunodetection of T. whipplei in intestinal tissues from Dr Whipple’s 1907 patient. Dumler et al. N Engl J Med 2003: 348:1411-2.
Genomic amplification by PCRPCR could be performed on various biopsies, body fluids, blood, stools or saliva using primers targeting various genes of the bacterium. The analysis of complete genome of the bacterium has allowed a rationalisation for the choice of primers. A real-time PCR targeting repeated sequences of T. whipplei has allowed an increasing of sensitivity without altering the specificity of the technique. T. whipplei DNA has been detected in saliva, small-bowel biopsies, gastric fluid and stools of healthy people. However, these data should be interpreted cautiously as they are based on « home-made » PCR and have never been confirmed by other teams. The exact prevalence of asymptomatic carriers of T. whipplei need still to be determined. The problem with PCR is the risk of contamination. To conclude to the positivity of a sample, it is necessary to obtain 2 positive PCR targeting 2 different DNA sequences. Culture The culture from biopsies (duodenum, cardiac valve…), body fluids (CSF) or blood could be performed using cell culture technique or axenic medium supplemented with amino acids. References: -Use of genome selected repeated sequences increases the sensitivity of PCR detection of T. whipplei. Fenollar et al. J Clin Microbiol 2004: 42, 401-3. -Culture of T. whipplei from human samples: a 3-year experience (1999 to 2002). J Clin Microbiol 2003: 41, 3816-22.
Page 1 and 2: SUMMARY : Whipple’s disease and T
Page 3 and 4: What about the micro-organism? The
Page 5 and 6: Habitat, source, and transmission o
Page 7 and 8: Clinical manifestations of Whipple
Page 9: The hemogram could show an anemia.
Page 13 and 14: Interpretation of results ? When a
Page 15 and 16: Treatment of Whipple’s disease? -
Page 17 and 18: Secondary effects of treatment? -Do
Page 19 and 20: Follow-up of the treated patients?
Page 21 and 22: Lists of the publications from IFR
Page 23 and 24: Interlocutors on IFR 48 Pr Didier R
Page 25 and 26: Sheet of clinical information
Page 27: The diagnosis could be performed by

Whipple's disease and Tropheryma whipplei

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