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Moro L, Zavarise G, Castagna G, Pomari E, Perandin F, Piubelli C, Mazzi C, Beltrame A. Tropheryma whipplei Colonization in Adults and Children: A Prospective Study. Microorganisms 2024; 12:1395. [PMID: 39065163 PMCID: PMC11279100 DOI: 10.3390/microorganisms12071395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024] Open
Abstract
We conducted a prospective cohort study at the IRCCS Sacro Cuore Don Calabria Hospital in Negrar di Valpolicella from 2019 to 2021 to investigate the duration of T. whipplei colonization. In addition, the correlation between persistent colonization and the continent of origin, current treatment regimen, clinical manifestations, and parasite coinfection was evaluated. The cohort included subjects who were tested in a previous study (years 2014-2016) and found to be positive for T. whipplei DNA in fecal samples. Thirty-three subjects were enrolled in a prospective study between 2019 and 2021. Feces, saliva, urine, and blood were collected at baseline and after 12 months. Medical history, current treatment, and symptoms were recorded. Among them, 25% showed persistent intestinal or oral colonization, 50% had no colonization at both visits, and 25% had intermittent colonization. No association was found between persistent T. whipplei colonization and subjects' continent of origin, current treatment regimen, initial clinical manifestations, and parasite coinfection. The longest duration of persistent T. whipplei intestinal colonization exceeded six years, with 11 subjects presenting persistent positivity for more than three years, including 1 minor. Our research was limited by the lack of a strain-specific identification of T. whipplei that made it impossible to distinguish between persistence of the same T. whipplei strain, reinfection from household exposure, or infection by a new strain. Larger prospective studies are needed to further explore the implications of this persistence and determine the key factors influencing the duration of colonization and its potential health impacts.
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Affiliation(s)
- Lucia Moro
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy; (E.P.); (F.P.); (C.P.); (C.M.)
| | - Giorgio Zavarise
- Pediatric Department, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy;
| | - Giada Castagna
- Obstetrics Unit, Women’s and Children’s Health Department Gynecology, University of Padua, 35122 Padova, PD, Italy;
| | - Elena Pomari
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy; (E.P.); (F.P.); (C.P.); (C.M.)
| | - Francesca Perandin
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy; (E.P.); (F.P.); (C.P.); (C.M.)
| | - Chiara Piubelli
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy; (E.P.); (F.P.); (C.P.); (C.M.)
| | - Cristina Mazzi
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy; (E.P.); (F.P.); (C.P.); (C.M.)
| | - Anna Beltrame
- College of Public Health, University of South Florida, Tampa, FL 33620, USA;
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Saffioti C, Nebiolo M, Caorsi R, Mesini A, Severino M, Brisca G, Castagnola E, Gattorno M. Whipple Disease Presenting as Isolated Transverse Myelitis with Permanent Neurological Damage in a Patient with Systemic Lupus Erythematosus: A Case Report of a Difficult Diagnosis with a Literature Review. Infect Dis Rep 2024; 16:269-280. [PMID: 38525769 PMCID: PMC10961757 DOI: 10.3390/idr16020022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/03/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024] Open
Abstract
We describe an atypical case of Whipple disease exclusively involving the spinal cord in an adolescent receiving immunosuppressive therapy for systemic lupus erythematosus. The diagnosis was particularly difficult since lupus and Whipple disease can present similar clinical features and the patient's prolonged contact with sewage was initially not mentioned. A literature review of the clinical, imaging, diagnostic, and therapeutic challenges of Whipple disease is also performed.
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Affiliation(s)
- Carolina Saffioti
- Pediatric Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (C.S.); (A.M.); (E.C.)
| | - Marta Nebiolo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy;
| | - Roberta Caorsi
- Rheumatolgy and Autoinflammatory Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (R.C.); (M.G.)
| | - Alessio Mesini
- Pediatric Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (C.S.); (A.M.); (E.C.)
| | | | - Giacomo Brisca
- Paediatric and Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elio Castagnola
- Pediatric Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (C.S.); (A.M.); (E.C.)
| | - Marco Gattorno
- Rheumatolgy and Autoinflammatory Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (R.C.); (M.G.)
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Du ZM, Chen P. Co-infection of Chlamydia psittaci and Tropheryma whipplei: A case report. World J Clin Cases 2023; 11:7144-7149. [PMID: 37946759 PMCID: PMC10631409 DOI: 10.12998/wjcc.v11.i29.7144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/15/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The co-infection of Chlamydia psittaci (C. psittaci) and Tropheryma whipplei (T. whipplei) is unusual, and the detection of pathogenic microorganisms is particularly important for patients with severe diseases or poor experience in treatment. Early identification of pathogens can significantly improve the prognosis of the patients. Targeted next-generation sequencing (tNGS) is currently widely used in clinical practice for various infectious diseases, including respiratory infections, to achieve early, accurate, and rapid microbial diagnosis. CASE SUMMARY We report a case of a 40-year-old female patient with a history of contact with parrots who was diagnosed with C. psittaci and T. whipplei infection through bronchial lavage fluid targeted next generation sequencing. After moxifloxacin treatment, the patient's symptoms improved significantly, and the imaging changes were obviously resolved. CONCLUSION Coinfection with C. psittaci and T. whipplei is not common. In this case, timely and accurate identification of both pathogens was achieved using tNGS. Moreover, the efficacy of monotherapy with moxifloxacin was confirmed.
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Affiliation(s)
- Zhu-Man Du
- Respiratory and Critical Care Discipline, Clinical Medicine College, Affiliated Hospital of Chengdu University, Chengdu 610000, Sichuan Province, China
| | - Pei Chen
- Respiratory and Critical Care Discipline, Clinical Medicine College, Affiliated Hospital of Chengdu University, Chengdu 610000, Sichuan Province, China
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Lin M, Wang K, Qiu L, Liang Y, Tu C, Chen M, Wang Z, Wu J, Huang Y, Tan C, Chen Q, Zheng X, Liu J. Tropheryma whipplei detection by metagenomic next-generation sequencing in bronchoalveolar lavage fluid: A cross-sectional study. Front Cell Infect Microbiol 2022; 12:961297. [PMID: 36061864 PMCID: PMC9428251 DOI: 10.3389/fcimb.2022.961297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/29/2022] [Indexed: 12/19/2022] Open
Abstract
Tropheryma whipplei is the bacterium associated with Whipple’s disease (WD), a chronic systemic infectious disease primarily involving the gastrointestinal tract. T. whipplei can also be detected in different body site of healthy individuals, including saliva and feces. Traditionally, Tropheryma whipplei has a higher prevalence in bronchoalveolar lavage fluid (BALF) of immunocompromised individuals. Few studies have explored the significance of the detection of T. whipplei in BALF. Herein, we retrospectively reviewed 1725 BALF samples which detected for metagenomic next-generation sequencing (mNGS) from March 2019 to April 2022 in Zhuhai, China. Seventy BALs (70/1725, 4.0%) from 70 patients were positive for T. whipplei. Forty-four patients were male with an average age of 50 years. The main symptoms included cough (23/70), expectoration (13/70), weight loss (9/70), and/or dyspnea (8/70), but gastrointestinal symptoms were rare. Chronic liver diseases were the most common comorbidity (n=15, 21.4%), followed by diabetes mellitus (n=13, 18.6%). Only nine patients (12.9%) were immunocompromised. Twenty-four patients (34.3%) were finally diagnosed with reactivation tuberculosis and 15 patients (21.4%) were diagnosed with lung tumors, including 13 primary lung adenocarcinoma and two lung metastases. Fifteen patients (21.4%) had pneumonia. Among the 20 samples, T. whipplei was the sole agent, and Mycobacterium tuberculosis complex was the most common detected other pathogens. Among the non-tuberculosis patients, 31 (31/46, 67.4%) had ground glass nodules or solid nodules on chest CT. Our study indicates that T. whipplei should be considered as a potential contributing factor in some lung diseases. For non-immunocompromised patients, the detection of T. whipplei also needs attention. The mNGS technology improves the detection and attention of rare pathogens. In the future, the infection, colonization, and prognosis of T. whipplei in lung still need to be studied.
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Affiliation(s)
- Minmin Lin
- Department of Pulmonary and Critical Care Medicine (PCCM), the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Kongqiu Wang
- Department of Pulmonary and Critical Care Medicine (PCCM), the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Lidi Qiu
- Department of Infectious Disease Intensive Care Unit, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Yingjian Liang
- Department of Pulmonary and Critical Care Medicine (PCCM), the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Changli Tu
- Department of Pulmonary and Critical Care Medicine (PCCM), the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Meizhu Chen
- Department of Pulmonary and Critical Care Medicine (PCCM), the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Zhenguo Wang
- Department of Pulmonary and Critical Care Medicine (PCCM), the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Jian Wu
- Department of Pulmonary and Critical Care Medicine (PCCM), the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Yiying Huang
- Department of Pulmonary and Critical Care Medicine (PCCM), the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Cuiyan Tan
- Department of Pulmonary and Critical Care Medicine (PCCM), the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Qijiu Chen
- Department of Pulmonary and Critical Care Medicine (PCCM), the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xiaobin Zheng
- Department of Pulmonary and Critical Care Medicine (PCCM), the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Jing Liu
- Department of Pulmonary and Critical Care Medicine (PCCM), the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- *Correspondence: Jing Liu,
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Tropheryma whipplei, Helicobacter pylori, and Intestinal Protozoal Co-Infections in Italian and Immigrant Populations: A Cross-Sectional Study. Microorganisms 2022; 10:microorganisms10040769. [PMID: 35456819 PMCID: PMC9027763 DOI: 10.3390/microorganisms10040769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 12/28/2022] Open
Abstract
Tropheryma whipplei (TW), Helicobacter pylori (HP), and intestinal protozoa (IP) are widespread pathogens with similar routes of transmission and epidemiological risk factors. Epidemiological data on co-infection between TW, HP, and IP are scarce. We aim to more deeply investigate the co-infection rate for these pathogens, evaluating the risk factors and symptoms. Methods: This is a cross-sectional study conducted at the IRCCS Sacro Cuore Don Calabria Hospital in Northern Italy, a referral center for tropical and Whipple’s disease (WD). Stored stool samples from 143 subjects previously tested for TW DNA by real-time PCR were explored for HP and IP DNA detection. The virulence factor cagA was investigated in HP-positive patients. Results: A history of migration was reported significantly more in TW-positive than in negative subjects (34.1% vs. 9.1%, p = 0.001) and in HP-infected than in those non-infected (59.1% vs. 9.1%, p < 0.001). The HP infection rate differed significantly between TW-infected and uninfected groups (31.8% vs. 8.1%, p = 0.001), while no difference was observed for IP infection. Significantly higher TW intestinal colonization was found in HP-infected patients than in non-infected (63.6% vs. 24.8%, p < 0.001). In addition, the proportion of Blastocysts positive finding was also significantly higher in HP-infected than in non-infected (40.9% vs. 17.4%, p = 0.018). Conclusions: The present study is the first to report a high TW and HP co-infection rate. To reduce the risk of morbidity from a chronic infection of either pathogen, clinicians may consider TW-HP molecular screening on the same stool sample for patients with suspected HP disease or WD, particularly in case of travel history.
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Ayona D, Zarza SM, Landemarre L, Roubinet B, Decloquement P, Raoult D, Fournier PE, Desnues B. Human galectin-1 and galectin-3 promote Tropheryma whipplei infection. Gut Microbes 2022; 13:1-15. [PMID: 33573443 PMCID: PMC7889132 DOI: 10.1080/19490976.2021.1884515] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Tropheryma whipplei, is an actinobacterium that causes different infections in humans, including Whipple's disease. The bacterium infects and replicates in macrophages, leading to a Th2-biased immune response. Previous studies have shown that T. whipplei harbors complex surface glycoproteins with evidence of sialylation. However, the exact contribution of these glycoproteins for infection and survival remains obscure. To address this, we characterized the bacterial glycoprofile and evaluated the involvement of human β-galactoside-binding lectins, Galectin-1 (Gal-1) and Galectin-3 (Gal-3) which are highly expressed by macrophages as receptors for bacterial glycans. Tropheryma whipplei glycoproteins harbor different sugars including glucose, mannose, fucose, β-galactose and sialic acid. Mass spectrometry identification revealed that these glycoproteins were membrane- and virulence-associated glycoproteins. Most of these glycoproteins are highly sialylated and N-glycosylated while some of them are rich in poly-N-acetyllactosamine (Poly-LAcNAc) and bind Gal-1 and Gal-3. In vitro, T. whipplei modulates the expression and cellular distribution of Gal-1 and Gal-3. Although both galectins promote T. whipplei infection by enhancing bacterial cell entry, only Gal-3 is required for optimal bacterial uptake. Finally, we found that serum levels of Gal-1 and Gal-3 were altered in patients with T. whipplei infections as compared to healthy individuals, suggesting that galectins are also involved in vivo. Among T. whipplei membrane-associated proteins, poly-LacNAc rich-glycoproteins promote infection through interaction with galectins. T. whipplei modulates the expression of Gal-1 and Gal-3 both in vitro and in vivo. Drugs interfering with galectin-glycan interactions may provide new avenues for the treatment and diagnosis of T. whipplei infections.
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Affiliation(s)
- Diyoly Ayona
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France,IHU-Méditerranée Infection, Marseille, France
| | - Sandra Madariaga Zarza
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France,IHU-Méditerranée Infection, Marseille, France
| | | | - Benoît Roubinet
- Glycodiag, Rue De Chartres, BP6759, 45067, Orléans cedex 2, France
| | - Philippe Decloquement
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France,IHU-Méditerranée Infection, Marseille, France
| | - Didier Raoult
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France,IHU-Méditerranée Infection, Marseille, France
| | - Pierre-Edouard Fournier
- IHU-Méditerranée Infection, Marseille, France,Aix Marseille Univ, IRD, APHM, VITROME, Marseille, France,Pierre-Edouard Fournier Aix Marseille Univ, VITROME, IHU - Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005Marseille, France
| | - Benoit Desnues
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France,IHU-Méditerranée Infection, Marseille, France,CONTACT Benoit Desnues MEPHI, IHU - Méditerranée Infection, Aix Marseille Univ, 19-21 Boulevard Jean Moulin, 13005, Marseille, France
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Eberhardt KA, Sarfo FS, Klupp EM, Dompreh A, Di Cristanziano V, Osei Kuffour E, Boateng R, Norman B, Phillips RO, Aepfelbacher M, Feldt T. Intestinal Colonization with Tropheryma whipplei-Clinical and Immunological Implications for HIV Positive Adults in Ghana. Microorganisms 2021; 9:1781. [PMID: 34442860 PMCID: PMC8400997 DOI: 10.3390/microorganisms9081781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/13/2021] [Accepted: 08/18/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Recent studies demonstrated higher prevalence rates of Tropheryma whipplei (T. whipplei) in HIV positive than in HIV negative subjects. However, associations with the immune status in HIV positive participants were conflicting. METHODS For this cross-sectional study, stool samples of 906 HIV positive and 98 HIV negative individuals in Ghana were tested for T. whipplei. Additionally, sociodemographic parameters, clinical symptoms, medical drug intake, and laboratory parameters were assessed. RESULTS The prevalence of T. whipplei was 5.85% in HIV positive and 2.04% in HIV negative participants. Within the group of HIV positive participants, the prevalence reached 7.18% in patients without co-trimoxazole prophylaxis, 10.26% in subjects with ART intake, and 12.31% in obese participants. Frequencies of clinical symptoms were not found to be higher in HIV positive T. whipplei carriers compared to T. whipplei negative participants. Markers of immune activation were lower in patients colonized with T. whipplei. Multivariate regression models demonstrated an independent relationship of a high CD4+ T cell count, a low HIV-1 viral load, and an obese body weight with the presence of T. whipplei. CONCLUSIONS Among HIV positive individuals, T. whipplei colonization was associated with a better immune status but not with clinical consequences. Our data suggest that the withdrawal of co-trimoxazole chemoprophylaxis among people living with HIV on stable cART regimen may inadvertently increase the propensity towards colonization with T. whipplei.
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Affiliation(s)
- Kirsten Alexandra Eberhardt
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20359 Hamburg, Germany
- Institute for Transfusion Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, 00233 Kumasi, Ghana; (F.S.S.); (B.N.); (R.O.P.)
- Department of Medicine, Komfo Anokye Teaching Hospital, 00233 Kumasi, Ghana
| | - Eva-Maria Klupp
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf, 20251 Hamburg, Germany; (E.-M.K.); (M.A.)
| | - Albert Dompreh
- Department of Clinical Microbiology, Komfo Anokye Teaching Hospital, 00233 Kumasi, Ghana; (A.D.); (R.B.)
| | - Veronica Di Cristanziano
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany;
| | - Edmund Osei Kuffour
- Laboratory of Retrovirology, The Rockefeller University, New York, NY 10065, USA;
| | - Richard Boateng
- Department of Clinical Microbiology, Komfo Anokye Teaching Hospital, 00233 Kumasi, Ghana; (A.D.); (R.B.)
| | - Betty Norman
- Department of Medicine, Kwame Nkrumah University of Science and Technology, 00233 Kumasi, Ghana; (F.S.S.); (B.N.); (R.O.P.)
- Department of Medicine, Komfo Anokye Teaching Hospital, 00233 Kumasi, Ghana
| | - Richard Odame Phillips
- Department of Medicine, Kwame Nkrumah University of Science and Technology, 00233 Kumasi, Ghana; (F.S.S.); (B.N.); (R.O.P.)
- Department of Medicine, Komfo Anokye Teaching Hospital, 00233 Kumasi, Ghana
- Kumasi Center for Collaborative Research in Tropical Medicine, 00233 Kumasi, Ghana
| | - Martin Aepfelbacher
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf, 20251 Hamburg, Germany; (E.-M.K.); (M.A.)
| | - Torsten Feldt
- Clinic of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, 40225 Düsseldorf, Germany;
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Feurle GE, Moos V, Landt O, Corcoran C, Reischl U, Maiwald M. Tropheryma whipplei in Feces of Patients with Diarrhea in 3 Locations on Different Continents. Emerg Infect Dis 2021; 27:932-935. [PMID: 33622479 PMCID: PMC7920677 DOI: 10.3201/eid2703.200182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We examined fecal specimens of patients with diarrhea from 3 continents for Tropheryma whipplei and enteropathogens. T. whipplei was most common in South Africa, followed by Singapore and Germany. Its presence was associated with the presence of other pathogens. An independent causative role in diarrhea appears unlikely.
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Beltrame A, Ragusa A, Perandin F, Formenti F, Fenollar F, Edouard S, Laroche M, Zavarise G, Doro F, Giorli G, Raoult D, Bisoffi Z. Tropheryma whipplei intestinal colonization in Italian and migrant population: a retrospective observational study. Future Microbiol 2019; 14:283-292. [PMID: 30855186 DOI: 10.2217/fmb-2018-0347] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To obtain the first molecular epidemiological survey of Tropheryma whipplei intestinal colonization in Italy. Materials & methods: Retrospective, observational study to assess the prevalence of T. whipplei, the causative agent of Whipple's disease, in stool samples (real-time PCR) of patients attending the Center for Tropical Diseases (Italy) and risk factors associated. RESULTS Overall prevalence was 6.9% (85/1240). The younger age group showed a significantly higher rate than older age group (12.7 vs 5.9%, p = 0.002). The prevalence was 4.9% for Italians and 9.3% for migrants (p = 0.003). Among the latter, children less than 10 years had higher prevalence than older ones (17.3 vs 7.3%, p = 0.003). The young age, male gender and Giardia duodenalis and Entamoeba histolytica coinfection were risk factors. CONCLUSION Our study confirms an increased risk of acquiring T. whipplei infection during childhood, under poor sanitary conditions.
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Affiliation(s)
- Anna Beltrame
- Centre for Tropical Diseases, IRCCS Sacro Cuore - Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar, Italy
| | - Andrea Ragusa
- Centre for Tropical Diseases, IRCCS Sacro Cuore - Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar, Italy
| | - Francesca Perandin
- Centre for Tropical Diseases, IRCCS Sacro Cuore - Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar, Italy
| | - Fabio Formenti
- Centre for Tropical Diseases, IRCCS Sacro Cuore - Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar, Italy
| | - Florence Fenollar
- Aix Marseille Univ, AP-HM, MEPHI, IHU-Méditerranée Infection, 19-21 Bd Jean Moulin, 13005, France
| | - Sophie Edouard
- Aix Marseille Univ, AP-HM, MEPHI, IHU-Méditerranée Infection, 19-21 Bd Jean Moulin, 13005, France
| | - Maureen Laroche
- Aix Marseille Univ, AP-HM, MEPHI, IHU-Méditerranée Infection, 19-21 Bd Jean Moulin, 13005, France
| | - Giorgio Zavarise
- Paediatrics Department, IRCSS Sacro Cuore - Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar, Italy
| | - Francesco Doro
- Paediatrics Department, IRCSS Sacro Cuore - Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar, Italy
| | - Giovanni Giorli
- Centre for Tropical Diseases, IRCCS Sacro Cuore - Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar, Italy
| | - Didier Raoult
- Aix Marseille Univ, AP-HM, MEPHI, IHU-Méditerranée Infection, 19-21 Bd Jean Moulin, 13005, France
| | - Zeno Bisoffi
- Centre for Tropical Diseases, IRCCS Sacro Cuore - Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar, Italy.,Department of Diagnostic & Public Health, University of Verona, P.le L. A. Scuro 10, 37134 Verona, Italy
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Frickmann H, Hanke M, Hahn A, Schwarz NG, Landt O, Moter A, Kikhney J, Hinz R, Rojak S, Dekker D, Tannich E, Podbielski A. Detection of Tropheryma whipplei in stool samples by one commercial and two in-house real-time PCR assays. Trop Med Int Health 2018; 24:101-108. [PMID: 30347125 DOI: 10.1111/tmi.13172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Tropheryma whipplei, the causative agent of Whipple's disease, can also be identified in stool samples of humans without systemic disease. It is much more frequently detected in human stool samples in tropical environments than in industrialized countries. PCR-screening has been applied for point prevalence studies and environmental assessments in tropical settings, but results depend on the applied assay. We compared one commercial qPCR kit with two well-described in-house assays for detection of T. whipplei from stool. METHODS Residual materials from nucleic acid extractions of stool samples from two groups with presumably different prevalences and increased likelihood of being colonized or infected by T. whipplei were tested. One group comprised 300 samples from study participants from western Africa (group 1); the second group was of 300 returnees from tropical deployments (group 2). Each sample was assessed with all three qPCR assays. Cycle threshold (Ct ) values were descriptively compared. RESULTS Based solely on mathematical modeling, the three PCR assays showed considerably different detection rates of T. whipplei DNA in stool samples (kappa 0.67 (95% confidence interval [0.60, 0.73])). Considering the calculated test characteristics, prevalence of 28.3% for group 1 and 5.0% for group 2 was estimated. Discordant test results were associated with later Ct values. The study did not validate the assays for the detection of T. whipplei in Whipple's disease and for diagnostic purposes since clinical specificity and sensitivity were not investigated. CONCLUSIONS In spite of the observed diagnostic uncertainty, PCR-based screening approaches can be used for epidemiological purposes and environmental samples to define the source and reservoir in resource-limited tropical settings if prevalence is calculated using diagnostic accuracy-adjusted methods.
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Affiliation(s)
- Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Hamburg, Germany.,Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Miriam Hanke
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Andreas Hahn
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Norbert G Schwarz
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | | | - Annette Moter
- Institute for Microbiology, Charité - University Medicine Berlin, Berlin, Germany.,Biofilmcenter, German Heart Institute Berlin, Berlin, Germany
| | - Judith Kikhney
- Institute for Microbiology, Charité - University Medicine Berlin, Berlin, Germany.,Biofilmcenter, German Heart Institute Berlin, Berlin, Germany
| | - Rebecca Hinz
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Hamburg, Germany
| | - Sandra Rojak
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Hamburg, Germany.,Department of Tropical Medicine and Infectious Disease, Bundeswehr Hospital Hamburg, Hamburg, Germany
| | - Denise Dekker
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | - Egbert Tannich
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Andreas Podbielski
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
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11
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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: 88] [Impact Index Per Article: 12.6] [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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12
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García-Álvarez L, Sanz MM, Marín M, Fariñas M, Montejo M, Goikoetxea J, Rodríguez García R, de Alarcón A, Almela M, Fernández-Hidalgo N, Alonso Socas MDM, Goenaga MÁ, Navas E, Vicioso L, Oteo JA. Tropheryma whipplei endocarditis in Spain: Case reports of 17 prospective cases. Medicine (Baltimore) 2016; 95:e4058. [PMID: 27368042 PMCID: PMC4937956 DOI: 10.1097/md.0000000000004058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Tropheryma whipplei endocarditis is an uncommon condition with very few series and <90 cases reported in the literature. The aim of the study was to analyze the epidemiological, clinical, and outcome characteristics of 17 cases of T. whipplei endocarditis recruited in our country from a multicentric cohort from 25 Spanish hospitals from the Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España.From a total of 3165 cases included in the cohort, 14.2% were diagnosed of blood culture negative endocarditis (BCNE) and 3.5% of these had T. whipplei endocarditis. This condition was more frequent in men. The average age was 60.3 years. Previous cardiac condition was present in 35.3% of the cases. The main clinical manifestation was cardiac failure (76.5%) while fever was only present in the 35.3%. Ecocardiography showed vegetations in 64.7% of patients. Surgery was performed in all but 1 cases and it allowed the diagnosis when molecular assays were performed. A broad range rRNA 16S polymerase chain reaction was used for first instance in all laboratories and different specific targets for T. whipplei were employed for confirmation. A concomitant Whipple disease was diagnosed in 11.9% of patients. All patients received specific antimicrobial treatment for at least 1 year, with no relapse and complete recovery.T. whipplei endocarditis is an uncommon condition with an atypical presentation that must be considered in the diagnosis of BCNE. The prognosis is very good when an appropriate surgical management and antimicrobial-specific treatment is given.
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Affiliation(s)
- Lara García-Álvarez
- Departamento de Enfermedades Infecciosas, Hospital San Pedro-Centro de Investigación Biomédica de La Rioja (CIBIR)
| | | | - Mercedes Marín
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid
| | - MªCarmen Fariñas
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander
| | - Miguel Montejo
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Universidad del País Vasco
| | - Josune Goikoetxea
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Bilbao
| | - Raquel Rodríguez García
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo
| | - Arístides de Alarcón
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla
| | - Manuel Almela
- Servicio de Microbiología y Parasitología, Hospital Clinic de Barcelona, Barcelona
| | - Núria Fernández-Hidalgo
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, Barcelona
| | | | - Miguel Ángel Goenaga
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donosti, San Sebastián
| | - Enrique Navas
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid
| | - Luis Vicioso
- Servicio de Anatomía Patológica, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - José Antonio Oteo
- Departamento de Enfermedades Infecciosas, Hospital San Pedro-Centro de Investigación Biomédica de La Rioja (CIBIR)
- Correspondence: José A. Oteo, Departamento de Enfermedades Infecciosas, Hospital San Pedro-CIBIR, C/Piqueras 98-7a NE, 26006 Logroño (La Rioja), Spain ()
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