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Tao Y, Du R, Mao H. Tropheryma whipplei pneumonia revealed by Metagenomic next-generation sequencing: Report of two cases. Diagn Microbiol Infect Dis 2024; 110:116427. [PMID: 39024936 DOI: 10.1016/j.diagmicrobio.2024.116427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/20/2024]
Abstract
Tropheryma whipplei is the causative agent of Whipple's disease, which is a rare multiorgan systemic disease. We report two cases of Tropheryma whipplei infection, all routine tests were negative and it was finally detected by mNGS. This may help clinicians increase awareness of the diagnosis and treatment of acute severe pneumonia and interstitial pneumonia caused by Tropheryma whipplei.
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Affiliation(s)
- Yuhan Tao
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Rao Du
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Mao
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
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2
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Lai LM, Zhu XY, Zhao R, Chen Q, Liu JJ, Liu Y, Yuan L. Tropheryma whipplei detected by metagenomic next-generation sequencing in bronchoalveolar lavage fluid. Diagn Microbiol Infect Dis 2024; 109:116374. [PMID: 38805857 DOI: 10.1016/j.diagmicrobio.2024.116374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 05/30/2024]
Abstract
Whipple's disease is a chronic systemic infectious disease that mainly affects the gastrointestinal tract. In some cases, Tropheryma whipplei can cause infection at the implant site or even throughout the body. In this study, we collected alveolar lavage fluid samples from patients with Tropheryma whipplei from 2020 to 2022, and retrospectively analyzed the clinical data of Tropheryma whipplei positive patients. Patient's past history, clinical manifestations, laboratory examinations, chest CT findings, treatment, and prognosis were recorded. 16 BALFs (70/1725, 4.0 %) from 16 patients were positive for Tropheryma whipplei. 8 patients were male with an average age of 50 years. The main clinical symptoms of patients included fever (9/16), cough (7/16), dyspnea (7/16), and expectoration (5/16), but neurological symptoms and arthralgia were rare. Cardiovascular and cerebrovascular diseases were the most common comorbidity (n=8). The main laboratory characteristics of the patient are red blood cell count, hemoglobin, total protein and albumin below normal levels (11/16), and/or creatinine above normal levels(14/16). Most chest computed tomography mainly show focal or patchy heterogeneous infection (n=5) and pleural effusion (n=8). Among the 6 samples, Tropheryma whipplei was the sole agent, and Klebsiella pneumoniae was the most common detected other pathogens. Metagenomic next-generation sequencing technology has improved the detection rate and attention of Tropheryma whipplei. Further research is needed to distinguish whether Tropheryma whipplei present in respiratory samples is a pathogen or an innocent bystander.
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Affiliation(s)
- Lan Min Lai
- Department of Clinical laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, PR China
| | - Xin Yu Zhu
- Department of Clinical laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, PR China
| | - Rui Zhao
- Department of Clinical laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, PR China
| | - Qiang Chen
- Department of Clinical laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, PR China
| | - Jiao Jiao Liu
- Department of Clinical laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, PR China
| | - Yang Liu
- Department of Clinical laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, PR China
| | - Lei Yuan
- Department of Clinical laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, PR China.
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Shen Y, Cui SS, Teng XB, Han MF, Zhang YB. Clinical, Laboratory, and Imaging Characteristics of Tropheryma Whipplei Detection in Bronchoalveolar Lavage Fluid Using Next-Generation Sequencing: A Case-Control Study. Infect Drug Resist 2024; 17:3101-3112. [PMID: 39050831 PMCID: PMC11268753 DOI: 10.2147/idr.s470084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024] Open
Abstract
Objective The aim of this study was to assess the prevalence of Tropheryma whipplei (TW) infection in the population and to investigate the clinical symptoms, as well as the laboratory and imaging characteristics of patients testing positive for TW using next-generation sequencing (NGS). Methods A retrospective review was conducted on 1346 bronchoalveolar lavage fluid (BALF) samples collected between January 2021 and September 2023. The case group comprised patients with TW detected using NGS while the control group included 65 randomly chosen Gram-positive bacterial infection patients without TW. Comparative analyses were carried out on the basic demographics, laboratory parameters, and imaging findings between the two groups. Additionally, the case group underwent an in-depth examination of underlying diseases, pathogens, final diagnoses, treatment strategies. Results The case group comprised of 51 patients with TW, constituting 3.8% of the total. There was no significant difference in gender and age between the case and control groups (P = 0.84, P = 0.07). Symptoms such as coughing, expectoration, wheezing, fever, and hemoptysis are less commonly detected in the case group with a higher incidence of chest pain when compared to the control group (P >0.05). The case group exhibited decreased albumin levels and increased C-reactive protein and D-dimer levels compared to normal levels. Imaging findings in the case group commonly included nodules, patchy images, and interstitial changes, the most common underlying disease is cardiovascular disease, and the most frequently co-occurring pathogen is the human herpesvirus. Among the case group, 27 patients received a final diagnosis of pneumonia, and 3 patients clinically diagnosed with Whipple's disease demonstrated improvement in both symptoms and imaging after treatment. Conclusion NGS revealed a relatively low overall detection rate of TW-positive patients using BALF. TW was more prevalent in middle-aged and elderly male patients characterized by symptoms such as cough, expectoration, shortness of breath, and fever. Chest imaging in these cases typically showed nodules and interstitial changes.
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Affiliation(s)
- Ya Shen
- Department of Geriatric Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230000, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Fuyang Infectious Disease Clinical College of Anhui Medical University, Fuyang, 236000, People’s Republic of China
| | - Shun-Shun Cui
- Department of Respiratory and Critical Care Medicine, Fuyang People’s Hospital, Fuyang, 236000, People’s Republic of China
| | - Xiao-Bao Teng
- Department of Respiratory and Critical Care Medicine, Fuyang Infectious Disease Clinical College of Anhui Medical University, Fuyang, 236000, People’s Republic of China
| | - Ming-Feng Han
- Department of Respiratory and Critical Care Medicine, Fuyang Infectious Disease Clinical College of Anhui Medical University, Fuyang, 236000, People’s Republic of China
| | - Yan-Bei Zhang
- Department of Geriatric Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230000, People’s Republic of China
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Liu F, Yang X, He Z, OuYang C, Yang X, Yang C. Using Targeted Next-Generation Sequencing to Diagnose Severe Pneumonia Due to Tropheryma Whipplei and Human Metapneumovirus: A Case Report and Literature Review. Infect Drug Resist 2024; 17:1863-1868. [PMID: 38745678 PMCID: PMC11092972 DOI: 10.2147/idr.s451477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/17/2024] [Indexed: 05/16/2024] Open
Abstract
Background In addition to the well-known Whipple's disease (WD), Tropheryma Whipplei (TW) can also lead to acute pneumonia. There is no unified consensus on the susceptible population, pathogenesis, clinical manifestations, diagnostic criteria, and treatment options for TW pneumonia. Clinical Presentation and Intervention This is an elderly patient with multiple injuries caused by falling from a building, and was transferred to intensive care unit (ICU) for mechanical ventilation and empirical anti-infection treatment due to severe pneumonia, and then the results of targeted next-generation sequencing (tNGS) in patient's bronchoalveolar lavage fluid (BALF) suggested TW and human metapneumovirus (HMPV) infection, and after switching to anti-infective therapy for TW, the patient was successfully extubated and transferred out of the ICU. Conclusion This is the first case of using tNGS to diagnose severe pneumonia caused by TW and HMPV. We hope that our study can serve as a reference for the diagnosis and treatment of related cases in the future.
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Affiliation(s)
- Fang Liu
- Department of Intensive Care Unit, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, People’s Republic of China
| | - XuYong Yang
- Department of Pediatrics, Gaoxin Hospital of The First Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Zhaohui He
- Department of Intensive Care Unit, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, People’s Republic of China
| | - Chenghong OuYang
- Department of Intensive Care Unit, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, People’s Republic of China
| | - Xiaogang Yang
- Department of Intensive Care Unit, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, People’s Republic of China
| | - Chunli Yang
- Department of Intensive Care Unit, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, People’s Republic of China
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Li H, Wu J, Mai X, Zeng W, Cai S, Huang X, Zhou C, Li J, Jiang Q, Lai C, Xie C. Novel Patterns in High-Resolution Computed Tomography in Whipple Pneumonia. Emerg Infect Dis 2024; 30:1042-1045. [PMID: 38666708 PMCID: PMC11060448 DOI: 10.3201/eid3005.231130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2024] Open
Abstract
With the use of metagenomic next-generation sequencing, patients diagnosed with Whipple pneumonia are being increasingly correctly diagnosed. We report a series of 3 cases in China that showed a novel pattern of movable infiltrates and upper lung micronodules. After treatment, the 3 patients recovered, and lung infiltrates resolved.
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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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Jin X, Zhang C, Chen C, Wang X, Dong J, He Y, Zhang P. Tropheryma whipplei-induced plastic bronchitis in children: a case report. Front Pediatr 2023; 11:1185519. [PMID: 37351316 PMCID: PMC10282642 DOI: 10.3389/fped.2023.1185519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/22/2023] [Indexed: 06/24/2023] Open
Abstract
This article reports a case of a 7-year-old child with severe pneumonia whose chest CT showed pulmonary consolidation, and bronchoscopy revealed plastic bronchitis. The metagenomic Next-Generation Sequencing (NGS) of the pulmonary lavage fluid suggested the infection of Tropheryma whipplei (T whipplei). The patient was treated with bronchial lavage to remove sputum plugs, intravenous azithromycin, and piperacillin-tazobactam and was discharged after eight days of hospitalization without any recurrence during follow-up. This article aims to raise clinical awareness of T whipplei infection and suggests that NGS for rare pathogens should be performed early for unexplained plastic bronchitis.
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Affiliation(s)
- Xuefeng Jin
- Department of Gastroenterology, Hangzhou Children's Hospital, Hangzhou, China
| | - Caiyun Zhang
- Pediatric Intensive Care Unit, Hangzhou Children's Hospital, Hangzhou, China
| | - Chao Chen
- Pediatric Intensive Care Unit, Hangzhou Children's Hospital, Hangzhou, China
| | - Xiaoning Wang
- Pediatric Intensive Care Unit, Hangzhou Children's Hospital, Hangzhou, China
| | - Jing Dong
- Pediatric Intensive Care Unit, Hangzhou Children's Hospital, Hangzhou, China
| | - Yuanyuan He
- Pediatric Intensive Care Unit, Hangzhou Children's Hospital, Hangzhou, China
| | - Peng Zhang
- Pediatric Intensive Care Unit, Hangzhou Children's Hospital, Hangzhou, China
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Fang Z, Liu Q, Tang W, Yu H, Zou M, Zhang H, Xue H, Lin S, Pei Y, Ai J, Chen J. Experience in the diagnosis and treatment of pneumonia caused by infection with Tropheryma whipplei: A case series. Heliyon 2023; 9:e17132. [PMID: 37484369 PMCID: PMC10361318 DOI: 10.1016/j.heliyon.2023.e17132] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/23/2023] [Accepted: 06/08/2023] [Indexed: 07/25/2023] Open
Abstract
Tropheryma whipplei (TW) is the root cause of Whipple's disease (WD), a rare infectious illness leading to multi-organ impairment. A prominent feature of WD is acute pneumonia, which can be exceedingly challenging to diagnose clinically due to the pathogen's surreptitious nature. However and significantly, with the advent of metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF), it offers clinicians a potent tool at their disposal to detect TW infections. The present study conducted a retrospective analysis of clinical data gleaned from five patients in Hunan Province in China. Findings in this study demonstrated the potential of BALF-mNGS in diagnosing pneumonia caused by TW infection.
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Affiliation(s)
- Zhixiong Fang
- Department of Infectious Disease and Public Health, Central Hospital of Xiangtan, Hunan province, China
| | - Qiong Liu
- Linxiang People’s Hospital, Hunan province, China
| | - Wei Tang
- Department of Infectious Disease and Public Health, Central Hospital of Xiangtan, Hunan province, China
| | - Hongyin Yu
- Center for Infectious Diseases, The First People's Hospital of Huaihua, Hunan, China
| | - Min Zou
- Department of Respiratory and Critical Care Medicine, The First People’s Hospital of Xiangtan City Affiliated to Nanhua University, Hunan, China
| | - Haiming Zhang
- Department of Infectious Disease and Public Health, Central Hospital of Xiangtan, Hunan province, China
| | - Haiyan Xue
- Department of Infectious Disease and Public Health, Central Hospital of Xiangtan, Hunan province, China
| | - Sha Lin
- Department of Infectious Disease and Public Health, Central Hospital of Xiangtan, Hunan province, China
| | - Yi Pei
- Department of Tuberculosis, Changsha Central Hospital, Changsha, China
| | - Jingwen Ai
- Department of Infectious Disease, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Jun Chen
- Department of Liver Diseases, Third Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China
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Ahmad AI, Wikholm C, Pothoulakis I, Caplan C, Lee A, Buchanan F, Kyoo Cho W. Whipple's disease review, prevalence, mortality, and characteristics in the United States: A cross-sectional national inpatient study. Medicine (Baltimore) 2022; 101:e32231. [PMID: 36626499 PMCID: PMC9750640 DOI: 10.1097/md.0000000000032231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Whipple's disease is a rare multiorgan systemic disease caused by Tropheryma whipplei infection that may present with a wide range of signs and symptoms. This study aim to comprehensively review and determine the inpatient prevalence, mortality, risk factors, and reasons for hospitalization of patients with Whipple's disease. ICD-10 codes were used to identify admissions with Whipple's disease during the years 2016 to 2018. Characteristics of admissions with and without Whipple's disease were compared. The most common reasons for hospitalization were identified in admissions with Whipple's disease. The prevalence of Whipple's disease was 4.6 per 1 million hospitalizations during the study period. Whipple's disease admissions were significantly older than other hospitalizations, with a mean age of 60.2 ± 1.6 years compared to 50.0 ± 0.1. Males were more likely to have Whipple's disease and represented approximately two-thirds of hospitalizations. A disproportionate number of admissions occurred in the Midwest. Patients with Whipple's disease were most commonly admitted for gastrointestinal disease, followed by systemic infection, cardiovascular/circulatory disease, musculoskeletal disease, respiratory disease, and neurological disease. High mortality was seen in admissions for central nervous system (CNS) disease. Whipple's disease has heterogeneous presentations for inpatient admissions, and disproportionately affects older males. High hospitalization rates in the Midwest support environmental and occupational disease transmission likely from the soil. Hospitalists should be aware of the various acute, subacute, and chronic presentations of this disease, and that acute presentations may be more common in the inpatient setting.
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Affiliation(s)
- Akram I. Ahmad
- Department of Internal Medicine, MedStar Washington Hospital Center Rather than Georgetown, Washington, D.C., USA
| | - Colin Wikholm
- Georgetown University School of Medicine, Washington, D.C., USA
| | - Ioannis Pothoulakis
- Department of Internal Medicine, MedStar Washington Hospital Center Rather than Georgetown, Washington, D.C., USA
| | - Claire Caplan
- Georgetown University School of Medicine, Washington, D.C., USA
| | - Arielle Lee
- Georgetown University School of Medicine, Washington, D.C., USA
| | - Faith Buchanan
- Department of Internal Medicine, MedStar Washington Hospital Center Rather than Georgetown, Washington, D.C., USA
| | - Won Kyoo Cho
- Department of Internal Medicine, MedStar Washington Hospital Center Rather than Georgetown, Washington, D.C., USA
- Department of Gastroenterology, MedStar Georgetown University Hospital, Washington, D.C., USA
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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: 15] [Impact Index Per Article: 7.5] [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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Sayyahfar S, Latifian M, Esmaeili P, Baseri N, Bagheri Amiri F, Bakhshi B, Esteghamati A, Esmaeili S. Tropheryma whipplei in the stool samples of children with acute diarrhea: a study from Tehran, Iran. BMC Infect Dis 2022; 22:193. [PMID: 35220952 PMCID: PMC8883655 DOI: 10.1186/s12879-022-07198-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/23/2022] [Indexed: 12/18/2022] Open
Abstract
Abstract
Background
Recently, Tropheryma whipplei has been suggested as one of the causative agents of diarrhea among children worldwide. Limited data is available on the prevalence of T. whipplei among children with diarrhea in most countries such as Iran. This study was conducted to evaluate the prevalence of T. whipplei in children with acute diarrhea in Iran.
Methods
In this study, the stool samples were collected from 130 children under 10 years old with acute diarrhea from children's hospitals in Tehran city. Genomic DNA was extracted from stool samples and was tested for the presence of DNA of T. whipplei using the SYBR Green Real-time PCR method. Positive T. whipplei samples were finally confirmed by PCR Product sequencing.
Results
The mean age of participants was 32.5 months, and 54.6% of children were female. Using the SYBR Green Real-time PCR, 9.23% (12/130) of samples were positive for T. whipplei, which were confirmed by sequencing. 66.67% of positive cases were males. The duration of diarrhea in infected children with T. whipplei (83.3%) was significantly longer (OR: 5.93, 95% CI 1.24–28.22) compared to children with negative results (45.8%). Other demographic factors and clinical signs had not a statistically significant relationship with T. whipplei infection.
Conclusions
In this study, T. whipplei was detected in stool samples of children with acute diarrhea. The results indicated that T. whipplei could be associated with childhood diarrhea in Iran. The health care system and physicians should be aware of the presence of T. whipplei infection in Iran, especially in childhood diarrhea.
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12
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Shams S, Niloofar Rezaie, Beltrame A, Moro L, Piubelli C, Amiri FB, Esmaeili S. Tropheryma whipplei intestinal colonization in immunocompromised children in Iran: a preliminary study. Future Microbiol 2021; 16:1161-1166. [PMID: 34615382 DOI: 10.2217/fmb-2021-0091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aim & method: Tropheryma whipplei causes Whipple's disease. Children are reservoirs of this bacterium. The aim of this study was to investigate the presence of T. whipplei in children with immunodeficiency in central Iran from July 2018 to February 2019. Stool samples were tested by SYBR Green and Taq-Man real-time PCR assays. For confirmation, the isolated DNA was sequenced. Results: One hundred and thirty children were enrolled. Acute lymphocytic leukemia was the most reported immunodeficient disease (77%), followed by non-Hodgkin lymphoma and retinoblastoma. Thirteen (10%) children had T. whipplei DNA in the stool; 11.4% of the children under 5 years old were positive. Conclusion: This is the first study showing the circulation of T. whipplei in Iran.
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Affiliation(s)
- Saeed Shams
- Cellular and Molecular Research Center, Qom University of Medical Sciences, Qom, 3736175513, Iran
| | - Niloofar Rezaie
- Department of Microbiology, Pasteur Institute of Iran, Tehran, 1316943551, Iran
| | - Anna Beltrame
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024, Italy
| | - Lucia Moro
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024, Italy
| | - Chiara Piubelli
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024, Italy
| | - Fahimeh Bagheri Amiri
- Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, 1316943551, Iran
| | - Saber Esmaeili
- Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, 1316943551, Iran
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13
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Yan J, Zhang B, Zhang Z, Shi J, Liu S, Qi J, Wang M. Case Report: Tropheryma whipplei Hide in an AIDS Patient With Pneumocystis Pneumonia. Front Public Health 2021; 9:663093. [PMID: 34485213 PMCID: PMC8414578 DOI: 10.3389/fpubh.2021.663093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/19/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction: Pneumocystis pneumonia (PCP) is one of the most common opportunistic infections in HIV-infected patients. However, coinfection with Tropheryma whipplei is infrequent in AIDS patients with PCP. Case Presentation: We report a 28-year-old male AIDS patient coinfected with T. whipplei and Pneumocystis jirovecii diagnosed in the bronchoalveolar lavage. After sulfamethoxazole-trimethoprim and meropenem treatment, the patient showed clinical improvement in 2 weeks. Conclusion: Clinicians need to be alert to the occurrence of T. whipplei infection in AIDS patients with PCP and timely diagnosis and antibacterial treatments are essential. This case may help clinicians for timely diagnosis of the coinfection of T. whipplei and P. jirovecii in AIDS patients.
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Affiliation(s)
- Jun Yan
- Department II of Infectious Diseases, Xixi Hospital of Hangzhou, Zhejiang University, Hangzhou, China
| | - Binhai Zhang
- Department II of Infectious Diseases, Xixi Hospital of Hangzhou, Zhejiang University, Hangzhou, China
| | - Zhongdong Zhang
- Department II of Infectious Diseases, Xixi Hospital of Hangzhou, Zhejiang University, Hangzhou, China
| | - Jinchuan Shi
- Department II of Infectious Diseases, Xixi Hospital of Hangzhou, Zhejiang University, Hangzhou, China
| | - Shourong Liu
- Department II of Infectious Diseases, Xixi Hospital of Hangzhou, Zhejiang University, Hangzhou, China
| | - Jianjiang Qi
- Department II of Infectious Diseases, Xixi Hospital of Hangzhou, Zhejiang University, Hangzhou, China
| | - Mengyan Wang
- Department II of Infectious Diseases, Xixi Hospital of Hangzhou, Zhejiang University, Hangzhou, China
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Zhang WM, Xu L. Pulmonary parenchymal involvement caused by Tropheryma whipplei. Open Med (Wars) 2021; 16:843-846. [PMID: 34131590 PMCID: PMC8174119 DOI: 10.1515/med-2021-0297] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/17/2021] [Accepted: 04/27/2021] [Indexed: 12/18/2022] Open
Abstract
We report a 26-year-old man with left chest pain for 4 days. His chest CT showed a cavity in the left upper lung. Tuberculosis was suspected first, but metagenomics next generation sequencing (mNGS) in bronchoalveolar lavage fluid only detected Tropheryma whipplei. Tropheryma whipplei is the pathogen of Whipple’s disease. The most frequently involved organs are the eyes, heart, and central nervous system. Pulmonary parenchymal involvement is rare. To our knowledge, this is the first reported case of pulmonary cavity caused by Tropheryma whipplei. Nineteen cases of pulmonary parenchymal involvement were found by literature search. The most common respiratory symptom was cough, followed by dyspnea/breathlessness and chest pain. The most common finding in chest imaging was pulmonary nodules, followed by interstitial changes and patchy infiltration. Our case and literature review highlighted that Tropheryma whipplei infection should be considered in the differential diagnosis of pulmonary cavity, pulmonary nodules, interstitial changes, and patchy infiltration. mNGS is helpful to improve diagnosis rate.
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Affiliation(s)
- Wen Mei Zhang
- Department of Respiratory Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600, YiShan Road, Shanghai, 200233, China
| | - Ling Xu
- Department of Respiratory Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600, YiShan Road, Shanghai, 200233, China
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15
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Li W, Zhang Q, Xu Y, Zhang X, Huang Q, Su Z. Severe pneumonia in adults caused by Tropheryma whipplei and Candida sp. infection: a 2019 case series. BMC Pulm Med 2021; 21:29. [PMID: 33451316 PMCID: PMC7810182 DOI: 10.1186/s12890-020-01384-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 12/20/2020] [Indexed: 12/18/2022] Open
Abstract
Background Whipple’s disease is a chronic infectious disease caused by the Gram-positive bacterium Tropheryma whipplei (TW), which not only affects the gastrointestinal tract and causes malabsorption of nutrients, but several other systems, such as the cardiovascular system, central nervous system, the joints, and the vascular system, can also be simultaneously involved. The aim of this report was to be able to alert the clinician to severe pneumonia caused by TW combined with Candida sp. Case presentation The case study was conducted on patients in September and November 2019. After routine examination and treatment, the results were not satisfactory. A bronchoalveolar lavage (BAL) using metagenomics next-generation sequencing was conducted on two adults who presented with fever, cough, and progressive dyspnea and who had no history of gastrointestinal symptoms, immunodeficiency diseases, or use of immunosuppressive agents. TW and Candida sp. were detected in in BAL. Conclusions This is a report of life-threatening pneumonia caused by TW combined with Candida sp. in a Chinese population.
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Affiliation(s)
- Wei Li
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Qun Zhang
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yanling Xu
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Xiyue Zhang
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Qian Huang
- Department of Radiology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Zhenzhong Su
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, Jilin, China.
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Cummings LA, Hoogestraat DR, Rassoulian-Barrett SL, Rosenthal CA, Salipante SJ, Cookson BT, Hoffman NG. Comprehensive evaluation of complex polymicrobial specimens using next generation sequencing and standard microbiological culture. Sci Rep 2020; 10:5446. [PMID: 32214207 PMCID: PMC7096443 DOI: 10.1038/s41598-020-62424-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/11/2020] [Indexed: 01/19/2023] Open
Abstract
Optimal clinical decision-making depends on identification of clinically relevant organisms present in a sample. Standard microbiological culture may fail to identify unusual or fastidious organisms and can misrepresent relative abundance of sample constituents. Culture-independent methods have improved our ability to deconvolute polymicrobial patient samples. We used next-generation 16S rRNA gene sequencing (NGS16S) to determine how often cultivatable organisms in complex polymicrobial samples are not reported by standard culture. Twenty consecutive bronchoalveolar lavage (BAL) samples were plated to standard and additional media; bacteria were identified by NGS16S analysis of DNA extracted directly from samples or from washed culture plates. 96% of organisms identified were cultivable, but only 21% were reported by standard culture, indicating that standard work-up provides an incomplete assessment of microbial constituents. Direct NGS16S correlated well with standard culture, identifying the same predominant organism in 50% of samples. When predominant organisms differed, NGS16S most often detected anaerobes, whose growth is unsupported by standard culture conditions for this specimen. NGS16S identified more organisms per sample and allowed identification of fastidious organisms, while culture was better at capturing organisms when bacterial load was low, and allowed incidental recovery of non-bacterial pathogens. Molecular and culture-based methods together detect more organisms than either method alone.
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Affiliation(s)
- Lisa A Cummings
- Departments of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Daniel R Hoogestraat
- Departments of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | | | | | - Stephen J Salipante
- Departments of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Brad T Cookson
- Departments of Laboratory Medicine, University of Washington, Seattle, Washington, USA.,Departments of Microbiology, University of Washington, Seattle, Washington, USA
| | - Noah G Hoffman
- Departments of Laboratory Medicine, University of Washington, Seattle, Washington, USA.
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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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18
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Bassene H, Mediannikov O, Socolovschi C, Ratmanov P, Keita AK, Sokhna C, Raoult D, Fenollar F. Tropheryma whipplei as a Cause of Epidemic Fever, Senegal, 2010-2012. Emerg Infect Dis 2018; 22:1229-334. [PMID: 27314980 PMCID: PMC4918168 DOI: 10.3201/eid2207.150441] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Findings suggest that the bacterium has role in febrile episodes, is contagious, and has an epidemic character. The bacterium Tropheryma whipplei, which causes Whipple disease in humans, is commonly detected in the feces of persons in Africa. It is also associated with acute infections. We investigated the role of T. whipplei in febrile patients from 2 rural villages in Senegal. During June 2010–March 2012, we collected whole-blood finger-prick samples from 786 febrile and 385 healthy villagers. T. whipplei was detected in blood specimens from 36 (4.6%) of the 786 febrile patients and in 1 (0.25%) of the 385 apparently healthy persons. Of the 37 T. whipplei cases, 26 (70.2%) were detected in August 2010. Familial cases and a potential new genotype were observed. The patients’ symptoms were mainly headache (68.9%) and cough (36.1%). Our findings suggest that T. whipplei is a cause of epidemic fever in Senegal.
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19
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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: 90] [Impact Index Per Article: 12.9] [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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20
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Head BM, Trajtman A, Rueda ZV, Vélez L, Keynan Y. Atypical bacterial pneumonia in the HIV-infected population. Pneumonia (Nathan) 2017; 9:12. [PMID: 28856082 PMCID: PMC5571654 DOI: 10.1186/s41479-017-0036-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/13/2017] [Indexed: 01/02/2023] Open
Abstract
Human immunodeficiency virus (HIV)-infected individuals are more susceptible to respiratory tract infections by other infectious agents (viruses, bacteria, parasites, and fungi) as their disease progresses to acquired immunodeficiency syndrome. Despite effective antiretroviral therapy, bacterial pneumonia (the most frequently occurring HIV-associated pulmonary illness) remains a common cause of morbidity and mortality in the HIV-infected population. Over the last few decades, studies have looked at the role of atypical bacterial pneumonia (i.e. pneumonia that causes an atypical clinical presentation or responds differently to typical therapeutics) in association with HIV infection. Due to the lack of available diagnostic strategies, the lack of consideration, and the declining immunity of the patient, HIV co-infections with atypical bacteria are currently believed to be underreported. Thus, following an extensive database search, this review aimed to highlight the current knowledge and gaps regarding atypical bacterial pneumonia in HIV. The authors discuss the prevalence of Chlamydophila pneumoniae, Mycoplasma pneumoniae, Coxiella burnetii, Legionella species and others in the HIV-infected population as well as their clinical presentation, methods of detection, and treatment. Further studies looking at the role of these microbes in association with HIV are required. Increased knowledge of these atypical bacteria will lead to a more rapid diagnosis of these infections, resulting in an improved quality of life for the HIV-infected population.
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Affiliation(s)
- Breanne M. Head
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada
| | - Adriana Trajtman
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada
| | - Zulma V. Rueda
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin, Colombia
| | - Lázaro Vélez
- Grupo Investigador de Problemas en Enfermedades Infecciosas, Universidad de Antioquia UdeA, Medellin, Colombia
| | - Yoav Keynan
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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21
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Lagier JC, Fenollar F, Raoult D. Acute infections caused by Tropheryma whipplei. Future Microbiol 2017; 12:247-254. [DOI: 10.2217/fmb-2017-0178] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Tropheryma whipplei is the causative bacterium of Whipple's disease. Its first culture has led to an enlargement of the field of the caused infections. Here, we comprehensively review acute T. whipplei infections. In a cohort study featuring 4000 children, T. whipplei was significantly more common in patients with diarrhea (4%) than in those without (1.7%). A case–controlled study highlighted 58 patients suffering from pneumonia with the detection of T. whipplei in their bronchoalveolar fluids. Finally, a recent study detected T. whipplei in the blood of 36 febrile patients experiencing pulmonary symptoms in a rural area of Senegal. T. whipplei is definitively an agent of acute gastroenteritis, a cause of nonmalarial fever in Africa, and probably a cause of pulmonary infections.
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Affiliation(s)
- Jean-Christophe Lagier
- Aix Marseille Université, URMITE, IHU Méditerranée-Infection, UM63, CNRS 7278, IRD 198, INSERM 1095, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France
| | - Florence Fenollar
- Aix Marseille Université, URMITE, IHU Méditerranée-Infection, UM63, CNRS 7278, IRD 198, INSERM 1095, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France
| | - Didier Raoult
- Aix Marseille Université, URMITE, IHU Méditerranée-Infection, UM63, CNRS 7278, IRD 198, INSERM 1095, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France
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22
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Simpson JL, Daly J, Baines KJ, Yang IA, Upham JW, Reynolds PN, Hodge S, James AL, Hugenholtz P, Willner D, Gibson PG. Airway dysbiosis: Haemophilus influenzae and Tropheryma in poorly controlled asthma. Eur Respir J 2015; 47:792-800. [PMID: 26647445 DOI: 10.1183/13993003.00405-2015] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 10/27/2015] [Indexed: 12/31/2022]
Abstract
Asthma is a chronic inflammatory disorder of the airways where bacteria may act as protagonists of chronic inflammation. Little is known about the relation of airway inflammation to the presence of specific bacterial taxa. We sought to describe the sputum microbiome in adults with poorly controlled asthma.DNA was extracted from induced sputum and microbial communities were profiled using 16S rRNA pyrosequencing. Bacterial species were characterised, and the relationship between microbial populations, asthma inflammatory subtypes and other covariates was explored. Real-time PCR was used to identify Tropheryma whipplei and Haemophilus influenzae in sputum.Adults with neutrophilic asthma had reduced bacterial diversity and species richness. Tropheryma was identified and confirmed with real-time PCR in 12 (40%) participants. Haemophilus occurred most often in a group of younger atopic males with an increased proportion of neutrophils. PCR confirmed the presence of H. influenzae in 35 (76%) participants with poorly controlled asthma.There are phenotype-specific alterations to the airway microbiome in asthma. Reduced bacterial diversity combined with a high prevalence of H. influenzae was observed in neutrophilic asthma, whereas eosinophilic asthma had abundant T. whipplei.
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Affiliation(s)
- Jodie L Simpson
- Respiratory and Sleep Medicine, School of Medicine and Public Health, Centre for Asthma and Respiratory Disease, The University of Newcastle, Callaghan, Australia
| | - Joshua Daly
- Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences and Institute for Molecular Bioscience, The University of Queensland, St Lucia, Australia
| | - Katherine J Baines
- Respiratory and Sleep Medicine, School of Medicine and Public Health, Centre for Asthma and Respiratory Disease, The University of Newcastle, Callaghan, Australia
| | - Ian A Yang
- School of Medicine, The University of Queensland, St Lucia, Australia Dept of Thoracic Medicine, The Prince Charles Hospital, Chermside, Australia
| | - John W Upham
- School of Medicine, The University of Queensland, St Lucia, Australia Dept of Respiratory Medicine, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Paul N Reynolds
- Dept of Thoracic Medicine, Royal Adelaide Hospital and Lung Research Laboratory, Hanson Institute, Adelaide, Australia School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Sandra Hodge
- Dept of Thoracic Medicine, Royal Adelaide Hospital and Lung Research Laboratory, Hanson Institute, Adelaide, Australia School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Alan L James
- Dept of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia School of Medicine and Pharmacology, University of Western Australia, Crawley, Australia
| | - Philip Hugenholtz
- Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences and Institute for Molecular Bioscience, The University of Queensland, St Lucia, Australia
| | - Dana Willner
- Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences and Institute for Molecular Bioscience, The University of Queensland, St Lucia, Australia
| | - Peter G Gibson
- Respiratory and Sleep Medicine, School of Medicine and Public Health, Centre for Asthma and Respiratory Disease, The University of Newcastle, Callaghan, Australia Woolcock Institute of Medical Research, Glebe, Australia
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23
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Current and past strategies for bacterial culture in clinical microbiology. Clin Microbiol Rev 2015; 28:208-36. [PMID: 25567228 DOI: 10.1128/cmr.00110-14] [Citation(s) in RCA: 294] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A pure bacterial culture remains essential for the study of its virulence, its antibiotic susceptibility, and its genome sequence in order to facilitate the understanding and treatment of caused diseases. The first culture conditions empirically varied incubation time, nutrients, atmosphere, and temperature; culture was then gradually abandoned in favor of molecular methods. The rebirth of culture in clinical microbiology was prompted by microbiologists specializing in intracellular bacteria. The shell vial procedure allowed the culture of new species of Rickettsia. The design of axenic media for growing fastidious bacteria such as Tropheryma whipplei and Coxiella burnetii and the ability of amoebal coculture to discover new bacteria constituted major advances. Strong efforts associating optimized culture media, detection methods, and a microaerophilic atmosphere allowed a dramatic decrease of the time of Mycobacterium tuberculosis culture. The use of a new versatile medium allowed an extension of the repertoire of archaea. Finally, to optimize the culture of anaerobes in routine bacteriology laboratories, the addition of antioxidants in culture media under an aerobic atmosphere allowed the growth of strictly anaerobic species. Nevertheless, among usual bacterial pathogens, the development of axenic media for the culture of Treponema pallidum or Mycobacterium leprae remains an important challenge that the patience and innovations of cultivators will enable them to overcome.
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24
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Lagier JC, Fenollar F, Raoult D. Maladie de Whipple et infections à Tropheryma whipplei. Quand l’interniste doit y penser ? Comment les traiter ? Rev Med Interne 2014; 35:801-7. [DOI: 10.1016/j.revmed.2014.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 03/03/2014] [Accepted: 04/22/2014] [Indexed: 12/17/2022]
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25
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Fenollar F, Lagier JC, Raoult D. Tropheryma whipplei and Whipple's disease. J Infect 2014; 69:103-12. [DOI: 10.1016/j.jinf.2014.05.008] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 05/15/2014] [Accepted: 05/19/2014] [Indexed: 11/26/2022]
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27
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Stein A, Doutchi M, Fenollar F, Raoult D. Tropheryma whippleiPneumonia in a Patient with HIV-2 Infection. Am J Respir Crit Care Med 2013; 188:1036-7. [DOI: 10.1164/rccm.201304-0692le] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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28
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Wetzstein N, Fenollar F, Buffet S, Moos V, Schneider T, Raoult D. Tropheryma whipplei genotypes 1 and 3, Central Europe. Emerg Infect Dis 2013; 19:341-2. [PMID: 23347594 PMCID: PMC3559045 DOI: 10.3201/eid1902.120709] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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29
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Keita AK, Raoult D, Fenollar F. Tropheryma whipplei as a commensal bacterium. Future Microbiol 2013; 8:57-71. [PMID: 23252493 DOI: 10.2217/fmb.12.124] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Tropheryma whipplei is the bacterial agent of the well-known and rare Whipple's disease, mainly observed among Caucasians. This bacterium has recently been involved in other chronic and acute infections. For a long time, the only known source of the bacterium was patients with Whipple's disease; however, thanks to the advent of molecular biology, T. whipplei has now been detected in specimens from healthy individuals, mainly in stool and saliva samples. The prevalence of carriage depends on several factors, such as age, exposure and geographical area, reaching 75% in stool specimens from children less than 4 years old in rural Africa. T. whipplei is a commensal bacterium that only causes Whipple's disease in a subset of individuals, probably those with a still-uncharacterized specific immunological defect.
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Affiliation(s)
- Alpha Kabinet Keita
- Aix Marseille Université, Unité des Rickettsies, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, CNRS/INSERM, Marseille, France
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Keita AK, Mediannikov O, Ratmanov P, Diatta G, Bassene H, Roucher C, Tall A, Sokhna C, Trape JF, Raoult D, Fenollar F. Looking for Tropheryma whipplei source and reservoir in rural Senegal. Am J Trop Med Hyg 2012; 88:339-43. [PMID: 23249690 DOI: 10.4269/ajtmh.2012.12-0614] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Tropheryma whipplei, the bacterium linked to Whipple's disease, is involved in acute infections and asymptomatic carriage. In rural Senegal, the prevalence of T. whipplei is generally high but is not homogeneous throughout households in the same village. We studied environmental samples collected in two Senegalese villages and conducted the survey to investigate the difference between households. Overall, the comparison between five households with very high T. whipplei prevalence and three households without any registered cases showed that the only difference was the presence of toilets in the latter (1/5 versus 3/3; P = 0.01423). Among the 1,002 environmental specimens (including domestic and synanthropic animals and dust sampled in households) tested for T. whipplei DNA, only four specimens were slightly positive. Humans are currently the predominant identified reservoir and source of T. whipplei in these populations. Limited access to toilets and exposure to human feces facilitate the fecal-oral transmission of T. whipplei.
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Affiliation(s)
- Alpha Kabinet Keita
- Aix Marseille Université, Unité des Rickettsies, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, INSERM 1095, 13005 Marseille, France.
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