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Rouanes N, Labadie C, Robledo JB, Moitsinga E, Biscay P. Une cause rare d’exophtalmie. Rev Med Interne 2017; 38:781-783. [DOI: 10.1016/j.revmed.2017.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/03/2017] [Indexed: 11/26/2022]
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Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections. Clin Microbiol Rev 2017; 30:529-555. [PMID: 28298472 DOI: 10.1128/cmr.00033-16] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Whipple's disease is a rare infectious disease that can be fatal if left untreated. The disease is caused by infection with Tropheryma whipplei, a bacterium that may be more common than was initially assumed. Most patients present with nonspecific symptoms, and as routine cultivation of the bacterium is not feasible, it is difficult to diagnose this infection. On the other hand, due to the generic symptoms, infection with this bacterium is actually quite often in the differential diagnosis. The gold standard for diagnosis used to be periodic acid-Schiff (PAS) staining of duodenal biopsy specimens, but PAS staining has a poor specificity and sensitivity. The development of molecular techniques has resulted in more convenient methods for detecting T. whipplei infections, and this has greatly improved the diagnosis of this often missed infection. In addition, the molecular detection of T. whipplei has resulted in an increase in knowledge about its pathogenicity, and this review gives an overview of the new insights in epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of Tropheryma whipplei infections.
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Braubach P, Lippmann T, Raoult D, Lagier JC, Anagnostopoulos I, Zender S, Länger FP, Kreipe HH, Kühnel MP, Jonigk D. Fluorescence In Situ Hybridization for Diagnosis of Whipple's Disease in Formalin-Fixed Paraffin-Embedded Tissue. Front Med (Lausanne) 2017; 4:87. [PMID: 28691008 PMCID: PMC5479881 DOI: 10.3389/fmed.2017.00087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/07/2017] [Indexed: 12/12/2022] Open
Abstract
Whipple’s disease (WD) is a rare chronic systemic infection with a wide range of clinical symptoms, routinely diagnosed in biopsies from the small intestine and other tissues by periodic acid–Schiff (PAS) diastase staining and immunohistological analysis with specific antibodies. The aim of our study was to improve the pathological diagnosis of WD. Therefore, we analyzed the potential of fluorescence in situ hybridization (FISH) for diagnosing WD, using a Tropheryma (T.) whipplei-specific probe. 19 formalin-fixed paraffin-embedded (FFPE) duodenal biopsy specimens of 12 patients with treated (6/12) and untreated (6/12) WD were retrospectively examined using PAS diastase staining, immunohistochemistry, and FISH. 20 biopsy specimens with normal intestinal mucosa, Helicobacter pylori, or mycobacterial infection, respectively, served as controls. We successfully detected T. whipplei in tissue biopsies with a sensitivity of 83% in untreated (5/6) and 40% in treated (4/10) cases of WD. In our study, we show that FISH-based diagnosis of individual vital T. whipplei in FFPE specimens is feasible and can be considered as ancillary diagnostic tool for the diagnosis of WD in FFPE material. We show that FISH not only detect active WD but also be helpful as an indicator for the efficiency of antibiotic treatment and for detection of recurrence of disease when the signal of PAS diastase and immunohistochemistry lags behind the recurrence of disease, especially if the clinical course of the patient and antimicrobial treatment is considered.
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Affiliation(s)
- Peter Braubach
- Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany
| | - Torsten Lippmann
- Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany
| | - Didier Raoult
- Aix Marseille University, CNRS, IRD, INSERM, AP-HM, URMITE, IHU Méditerranée Infection, Marseille, France
| | - Jean-Christophe Lagier
- Aix Marseille University, CNRS, IRD, INSERM, AP-HM, URMITE, IHU Méditerranée Infection, Marseille, France
| | | | - Steffen Zender
- Department of Gastroenterology, Hepatology, and Endocrinology, Centre for Internal Medicine, Hannover Medical School (MHH), Hanover, Germany
| | | | | | | | - Danny Jonigk
- Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany
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Abstract
In the differential diagnostics of autoimmune-mediated rheumatic diseases, rheumatologists often have to consider infections (e. g. Lyme arthritis) or reactive diseases (e. g. reactive arthritis after urogenital bacterial infections). Furthermore, infections with an atypical presentation or caused by atypical pathogens (opportunistic infections) can complicate the immunosuppressive therapy of autoimmune diseases. For this purpose not only conventional microbiological culture methods but also PCR-based methods are increasingly being applied for the direct detection of pathogens in clinical specimens. The aim of this overview is to present commonly used PCR methods in the clinical practice of rheumatology and to describe their benefits and limitations compared to culture-based detection methods.
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Affiliation(s)
- B Ehrenstein
- Klinik und Poliklinik für Rheumatologie/Klinische Immunologie, Asklepios Klinikum Bad Abbach, 93077, Bad Abbach, Deutschland.
| | - U Reischl
- Institut für Klinische Mikrobiologie und Hygiene, Universitätsklinikum Regensburg (UKR), 93053, Regensburg, Deutschland
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Papakonstantinou D, Riste MJ, Langman G, Moran E. Misdiagnosing Whipple's disease in the young. BMJ Case Rep 2017; 2017:bcr-2016-218866. [PMID: 28325722 DOI: 10.1136/bcr-2016-218866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Whipple's disease is considered an infection of middle-aged white men of European ancestry. Cases are rare and disproportionately associated with occupational exposure to soil or animals. We report the case of a man aged 22 years with no risk factors, erroneously diagnosed with, and treated for, toxoplasmosis on the basis of consistent lymph node histology. The correct diagnosis was delayed by the dramatic symptomatic improvement resulting from this therapy. Whipple's disease should be considered in cases of granulomatous lymphadenopathy of unknown cause, even if the age of the patient does not fit the classic presentation of the disease.
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Affiliation(s)
- Danai Papakonstantinou
- Department of Infectious Diseases and Tropical Medicine, Birmingham Heartlands Hospital, Heart of England NHS Hospital Trust, Birmingham, UK
| | - Michael J Riste
- Department of Infectious Diseases and Tropical Medicine, Birmingham Heartlands Hospital, Heart of England NHS Hospital Trust, Birmingham, UK
| | - Gerald Langman
- Histopathology Department, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Ed Moran
- Department of Infectious Diseases and Tropical Medicine, Birmingham Heartlands Hospital, Heart of England NHS Hospital Trust, Birmingham, UK
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Krums LM, Bodunova NA, Sabelnikova EA, Khomeriki SG, Mirzoev KM, Sokolova MS, Parfenov AI. Whipple’s disease: A clinical case report. TERAPEVT ARKH 2017; 89:103-104. [DOI: 10.17116/terarkh2017892103-104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The paper describes a 56-year-old female patient who in December 2015 lost her appetite and 20 kg of weight, had diarrhea, rapidly increasing weakness, dizziness, joint pains, fever, swelling of the feet, and convulsions. Blood tests revealed anemia, elevated erythrocyte sedimentation rate, and hypoproteinemia. Computed tomography showed enlarged mesenteric and retroperitoneal lymph nodes. The doctor suspected lymphoma and referred her to the Moscow Clinical Research Center. The diagnosis of Whipple’s disease was established by carrying out a small intestinal (duodenal) mucosal biopsy with the PAS reaction. A fat-free diet and antibiotic therapy with co-trimoxazole 2.0 g/day and ciprolen 0.3 g/day were prescribed for the patient. Fever and diarrhea disappeared, appetite appeared, weight gained, and blood counts normalized over 1 month of treatment. The patient was discharged with a recommendation to continue antibiotic treatment until the histopathological signs of the disease ceased.
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Elli L, Branchi F, Sidhu R, Guandalini S, Assiri A, Rinawi F, Shamir R, Das P, Makharia GK. Small bowel villous atrophy: celiac disease and beyond. Expert Rev Gastroenterol Hepatol 2017; 11:125-138. [PMID: 28000520 DOI: 10.1080/17474124.2017.1274231] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Small bowel villous atrophy can represent a diagnostic challenge for gastroenterologists and pathologists. In Western countries small bowel atrophy and mild non-atrophic alterations are frequently caused by celiac disease. However, other pathology can mimic celiac disease microscopically, widening the differential diagnosis. The several novelties on this topic and the introduction of the device-assisted enteroscopy in the diagnostic flowchart make an update of the literature necessary. Areas covered: In this review, a description of the different clinical scenarios when facing with small bowel mucosal damage, particularly small bowel atrophy, is described. The published literature on this subject has been summarized and reviewed. Expert commentary: When an intestinal mucosal alteration is histologically demonstrated, the pathology report forms part of a more complex workup including serological data, clinical presentation and clinical history. A multidisciplinary team, including pathologists and enteroscopy-devoted endoscopists, is frequently required to manage patients with small bowel alterations, especially in cases of severe malabsorption syndrome.
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Affiliation(s)
- Luca Elli
- a Center for Prevention and Diagnosis of Celiac Disease , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milano , Italy
| | - Federica Branchi
- a Center for Prevention and Diagnosis of Celiac Disease , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milano , Italy
| | - Reena Sidhu
- b Department of Gastroenterology , University of Sheffield, Royal Hallamshire Hospital , Sheffield , United Kingdom
| | - Stefano Guandalini
- c Department of Pediatrics, Section of Pediatric Gastroenterology , Hepatology and Nutrition, Celiac Disease Center, University of Chicago , Chicago , IL , USA
| | - Asaad Assiri
- d Prince Abdullah Bin Khalid Coeliac Disease Research Chair King Saud University , Riyadh , Saudi Arabia
| | - Firas Rinawi
- e Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center , Petach Tikva , Israel
| | - Raanan Shamir
- f Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, Israel AND Sackler Faculty of Medicine , Tel-Aviv University , Tel Aviv , Israel
| | - Prasenjit Das
- g Department of Pathology , All India Institute of Medical sciences , New Delhi , India
| | - Govind K Makharia
- h Department of Gastroenterology and Human Nutrition , All India Institute of Medical Sciences , New Delhi , India
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Juanmartiñena Fernández JF, Oyón Lara D, Rázquin Lizarraga S, Fernández Urien I. Whipple's disease under the vision of capsule endoscopy. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2016; 108:606. [PMID: 27128447 DOI: 10.17235/reed.2016.4362/2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We read with great interest the paper by Martínez-Sánchez et al. entitled Diagnóstico atípico mediante cápsula endoscópica: enfermedad de Whipple and we support their conclusions.
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Marth T, Moos V, Müller C, Biagi F, Schneider T. Tropheryma whipplei infection and Whipple's disease. THE LANCET. INFECTIOUS DISEASES 2016; 16:e13-22. [PMID: 26856775 DOI: 10.1016/s1473-3099(15)00537-x] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 12/01/2015] [Accepted: 12/11/2015] [Indexed: 12/12/2022]
Abstract
Recent advances in medical microbiology, epidemiology, cellular biology, and the availability of an expanded set of diagnostic methods such as histopathology, immunohistochemistry, PCR, and bacterial culture have improved our understanding of the clinical range and natural course of Tropheryma whipplei infection and Whipple's disease. Interdisciplinary and transnational research activities have contributed to the clarification of the pathogenesis of the disorder and have enabled controlled trials of different treatment strategies. We summarise the current knowledge and new findings relating to T whipplei infection and Whipple's disease.
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Affiliation(s)
- Thomas Marth
- Division of Internal Medicine, Krankenhaus Maria Hilf, Daun, Germany.
| | - Verena Moos
- Charité-University Medicine Berlin, Campus Benjamin Franklin, Division of Infectious Diseases, Berlin, Germany
| | - Christian Müller
- University Clinic of Internal Medicine III, Allgemeines Krankenhaus Vienna, Vienna, Austria
| | - Federico Biagi
- First Department of Internal Medicine, IRCCS Foundation Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Thomas Schneider
- Charité-University Medicine Berlin, Campus Benjamin Franklin, Division of Infectious Diseases, Berlin, Germany
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Kono M, Yamamoto K, Nagamatsu M, Kutsuna S. Use of polymerase chain reaction in the diagnosis of Whipple's disease. J Infect Chemother 2015; 21:885-8. [PMID: 26390825 DOI: 10.1016/j.jiac.2015.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 08/15/2015] [Accepted: 08/17/2015] [Indexed: 12/17/2022]
Abstract
Whipple's disease, a systemic, chronic infectious disease caused by Tropheryma whipplei, is extremely rare in Asian populations. A correct diagnosis is necessary due to its high mortality rate. Unfortunately, patients are apt to be misdiagnosed with connective tissue diseases since they typically present with arthritis or arthralgia. There are three diagnostic tools for Whipple's disease using intestinal tissues: 1) periodic acid-Schiff (PAS)-positive macrophages; 2) electron microscopic observation; and 3) polymerase chain reaction (PCR). It is challenging to diagnose this disease in the absence of histological findings, especially in Japan, where the clinical protocol currently used to make the diagnosis needs improvement, although symptomology and PCR results may be sufficient. Herein, we investigated a 24-year-old Japanese woman who had suffered from intermittent fever, migratory arthralgia, and watery diarrhea for several months. Her biopsied intestinal tissue was negative for foamy macrophages and PAS-positive cells, and electron microscopy did not provide diagnostic insight. PCR amplification of the specimens, however, successfully revealed T. whipplei. Whipple's disease was diagnosed based on a positive PCR result and strong clinical suspicion. The patient was treated parenterally with ceftriaxone (2 g daily) for two weeks, followed by oral treatment with 160 mg trimethoprim and 800 mg sulfamethoxazole twice per day. After one month of treatment, her symptoms disappeared and inflammatory markers returned to normal levels. This case illustrates the practicality and effectiveness of a PCR-based diagnostic test in combination with clinical suspicion to correctly diagnose Whipple's disease, especially in cases when a histological examination does not provide insight.
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Affiliation(s)
- Masanori Kono
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Maki Nagamatsu
- Department of Infectious Diseases, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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