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[whipple's disease].whipple's disease is a chronic, multisystemic, curable, bacterial infection that usually affects middle-aged men. it has a wide range of clinical manifestations. in the historical presentation, weight loss and diarrhoea are the most common symptoms and are preceded in three-quarters of cases by arthritis for a mean of six years. long-term, unexplained, seronegative oligoarthritis or polyarthritis of large joints with a palindromic or relapsing course is typical. in most patients, periodic acid-s ...200918722696
false-positive pcr detection of tropheryma whipplei in cerebrospinal fluid and biopsy samples from a child with chronic lymphocytic meningitis.we report the case of a teenager with chronic lymphocytic meningitis for whom tropheryma whipplei 16s rrna pcr results were positive in two cerebrospinal fluid samples and one duodenal biopsy specimen. pcr targeting another specific sequence of tropheryma whipplei and sequencing of the initially amplified 16s rrna fragment did not confirm the results.200919741072
reversible pulmonary hypertension in whipple disease: a case report with clinicopathological implications, and literature review.whipple disease is a rare multisystemic disorder of infectious aetiology caused by tropheryma whipplei. pulmonary hypertension is a rare association for which the underlying pathophysiological mechanism is unclear. our patient was a 54-year-old man with a 1-year history of progressive polyarticular arthritis, and worsening respiratory and gastrointestinal symptoms. pulmonary artery catheterisation demonstrated moderate-to-severe pulmonary hypertension. duodenal biopsies, with electron microscopy ...200921686934
complete resolution of primary sclerosing peritonitis ("abdominal cocoon") following long term therapy for tropheryma whipplei: a case report and review of literature.a 53-year-old man was admitted to our internal medicine unit with intestinal obstruction and signs of systemic inflammatory disease. clinical history was unremarkable until a few months earlier, when he began suffering from achilles tendonitis. diagnostic procedures, including laparotomy, revealed diffuse thickening of the peritoneum resembling sclerosing encapsulating peritonitis. biopsies showed reactive fibrosis. no known secondary causes were found and surgery was technically not feasible. c ...200921709845
whipple's disease: misdiagnosed as sarcoidosis with further tricuspid valve endocarditis and pulmonary embolism - a case report.gh whipple described a 36-year-old physician in 1907 with gradual loss of weight and strength, stools consisting chiefly of neutral fat and fatty acids, indefinite abdominal signs and a peculiar multiple arthritis. the patient died of this progressive illness. whipple called it intestinal lipodystrophy since he observed accumulation of large masses of neutral fats and fatty acids in the lymph spaces. it was renamed whipple's disease in 1949. an infectious aetiology was suspected as early as whip ...200921686811
whipple disease: unusual presentation of a protean and sometimes confusing disease.to describe an unusual case of whipple disease (wd) with confusing clinical features at onset and to discuss the diagnostic challenges for the clinician.200918538828
[whipple's disease with normal duodenal histology and ankylosing spondylitis].a 33-year-old woman with increasing back pain was referred to our hospital 8 years ago. as she had ankylosing sacroilitis and peripheral arthritis she was diagnosed as having ankolysing spondylitis with involvement of the peripheral joints. she recently developed persistent diarrhea, abdominal symptoms and weight loss.200919148854
erythema nodosum-like lesions in treated whipple's disease: signs of immune reconstitution inflammatory syndrome.treatment of systemic infections due to mycobacteria and hiv infection can lead to paradoxical worsening, the immune reconstitution inflammatory syndrome, in a minority of patients. herein we describe a patient with whipple's disease, a chronic systemic inflammatory disease caused by tropheryma whipplei, who developed cutaneous and later ocular disease after initiation of antibiotic therapy. a 42-year-old man with a 12-year history of arthralgias presented with deteriorating health, including we ...200919150271
the hla alleles drb1*13 and dqb1*06 are associated to whipple's disease.whipple's disease is a systemic, chronic, relapsing disorder caused by a combination of environmental (tropheryma whipplei) and unknown host factors. because it is a rare disease, the association between hla type and whipple's disease has been studied in only small numbers of patients; these studies have led to conflicting results. we aimed to investigate whether disease phenotype and outcome are associated with hla type in 122 patients with whipple's disease.200919208355
tropheryma whipplei glycosylation in the pathophysiologic profile of whipple's disease.tropheryma whipplei is a bacterium commonly found in people with whipple's disease, a rare systemic chronic infection. in the present study, we hypothesized that bacterium glycosylation may impair the immune response.200919222368
global proteomic pattern of tropheryma whipplei: a whipple's disease bacterium.the proteome of tropheryma whipplei, the intracellular bacterium responsible for whipple's disease (wd), was analyzed using two complementary approaches: 2-de coupled with maldi-tof and sds-page with nanolc-ms/ms. this strategy led to the identification of 206 proteins of 808 predicted orfs, resolving some questions raised by the genomic sequence of this bacterium. we successfully identified antibiotic targets and proteins with predicted n-terminal signal sequences. additionally, we identified a ...200919253299
resistance to trimethoprim/sulfamethoxazole and tropheryma whipplei.whipple's disease (wd) is a chronic infection caused by tropheryma whipplei. a 1-year treatment of oral trimethoprim/sulfamethoxazole (sxt) is commonly used. advances in the culture of t. whipplei have allowed for full genome sequencing and antibiotic susceptibility testing, which has demonstrated resistance of t. whipplei to trimethoprim. several mutations in the folp gene that encodes dihydropteroate synthase, the target of sulphonamides, has been reported for one patient with clinically acqui ...200919346107
tropheryma whipplei infection.whipple's disease was initially described in 1907. over the next century, the clinical and pathological features of this disorder have been better appreciated. most often, weight loss, diarrhea, abdominal and joint pain occur. occasionally, other sites of involvement have been documented, including isolated neurological disease, changes in the eyes and culture-negative endocarditis. in the past decade, the responsible organism tropheryma whipplei has been cultivated, its genome sequenced and its ...200919418579
multisegmental spondylitis due to tropheryma whipplei: case report.we report a patient who presented with inflammatory back pain due to multisegmental spondylitis. following a vertebral biopsy which failed to detect an infectious organism, the patient was treated with etanercept, a tumor necrosis factor (tnf)-alpha inhibitor, for suspected undifferentiated spondyloarthritis. the back pain worsened and the spondylitic lesions increased. only in a vertebral rebiopsy with polymerase chain reaction (pcr) amplification of tropheryma whipplei, the causative agent of ...200919493331
tropheryma whipplei in fecal samples from children, senegal.we tested fecal samples from 150 healthy children 2-10 years of age who lived in rural senegal and found the prevalence of tropheryma whipplei was 44%. unique genotypes were associated with this bacterium. our findings suggest that t. whipplei is emerging as a highly prevalent pathogen in sub-saharan africa.200919523292
[first centenary of whipple's disease].whipple's disease is an infrequent multisystemic infection caused by a gram-positive bacterium: tropheryma whippelii, which after several studies has been characterized as an actinomiceto por 16sr rna. it occurs with multiple symptoms, the principal of which are diarrhea, weight loss, stomach pain and arthralgias. arthritis or artralgia may appear as an isolated symptom and eventually through the years additional digestive, cardiovascular and/or neurological symptoms arise. diverse immunological ...200919623786
a paradoxical tropheryma whipplei western blot differentiates patients with whipple disease from asymptomatic carriers.tropheryma whipplei is a bacterium that causes whipple disease. however, t. whipplei can be carried in the gut of asymptomatic people, which may lead to difficulty in the interpretation of positive stool sample test results.200919635029
[whipple's disease].whipple's disease is a rare infectious disease. this review describes the clinical picture, diagnostic aspects and treatment options.200818552903
chorioretinitis and vitreitis due to tropheryma whipplei after transplantation: case report and review.whipple's disease is a very rare chronic multisystemic bacterial disease characterized by diarrhea, malabsorption, fever, and polyarthritis. ocular manifestations occur very rarely. previous reports have suggested that the use of immunosuppressive drugs appears to accelerate or exacerbate the clinical course of whipple's disease; however, the illness has yet to be reported in the setting of transplantation. herein, we describe what we believe is the first reported case of whipple's disease after ...200818564981
an atypical case of whipple's disease: case report and review of the literature.we report the case of a 57-year-old man, presenting with bilateral panuveitis, bilateral sacroiliitis, intermittent pyrexia and a pulmonary nodule. the patient had been under immunosuppressive treatment for 2 years for behçet's disease. however, he did not fulfill the diagnostic criteria of behçet's disease. blood analysis showed a very high c reactive protein (crp at 34 mg/dl). in view of severe intra-ocular inflammation, the anterior chamber was punctured. polymerase chain reaction (pcr) on th ...200818575052
serological microarray for a paradoxical diagnostic of whipple's disease.whipple's disease is a systemic chronic infection caused by tropheryma whipplei. asymptomatic people may carry t. whipplei in their digestive tract and this can be determined by pcr, making serological diagnosis useful to distinguish between carriers and patients. putative antigenic proteins were selected by computational analysis of the t. whipplei genome, immunoproteomics studies and from literature. after expression, putative t. whipplei antigens were screened by microimmunofluorescence with ...200818594884
value of tropheryma whipplei quantitative polymerase chain reaction assay for the diagnosis of whipple disease: usefulness of saliva and stool specimens for first-line screening.whipple disease (wd) is a chronic infectious disease caused by tropheryma whipplei. wd dna has been found in stool and saliva specimens from patients and asymptomatic carriers.200818662136
genotyping reveals a wide heterogeneity of tropheryma whipplei.tropheryma whipplei, the causative agent of whipple's disease, is associated with various clinical manifestations as well as an asymptomatic carrier status, and it exhibits genetic heterogeneity. however, relationships that may exist between environmental and clinical strains are unknown. herein, we developed an efficient genotyping system based on four highly variable genomic sequences (hvgss) selected on the basis of genome comparison. we analysed 39 samples from 39 patients with whipple's dis ...200818227256
prosthetic hip infection caused by tropheryma whipplei.we report a case of prosthetic hip infection due to tropheryma whipplei in a 74-year-old man not previously known to have whipple's disease. diagnosis was based on systematic 16s rrna gene amplification and sequencing of samples obtained during revision hip arthroplasty.200818287323
whipple's disease: new aspects of pathogenesis and treatment.100 years after its first description by george h whipple, the diagnosis and treatment of whipple's disease is still a subject of controversy. whipple's disease is a chronic multisystemic disease. the infection is very rare, although the causative bacterium, tropheryma whipplei, is ubiquitously present in the environment. we review the epidemiology of whipple's disease and the recent progress made in the understanding of its pathogenesis and the biology of its agent. the clinical features of whi ...200818291339
[whipple's disease with segmental lesions in the proximal small intestine].a 67-year-old man with anemia was referred to our hospital. he had suffered from rheumatoid arthritis for ten years. two months before admission he had been an inpatient at another hospital because of heart failure. he presented with edema, slightly elevated temperature and effusion in the right knee.200818302096
possible case of cns whipple's disease in an adolescent with aids.an adolescent with hiv/aids presented subacutely with progressive encephalopathy, spastic quadraplegia, and diarrhea. his brain biopsy was suggestive of central nervous system whipple's disease, a disease rarely described in hiv patients. due to overlapping, nonspecific symptoms associated with several opportunistic infections and to the difficulty in culturing the causative organism tropheryma whipplei, whipple's disease may be more common than previously suspected, and it is an important consi ...200818319513
[tropheryma whipplei and whipple disease: false positive pcr detections of tropheryma whipplei in diagnostic samples are rare].pcr can be used to detect t. whipplei (tw) in samples from variable tissue types and body fluids. we report clinical, evolutive characteristics and final diagnosis in patients with positive tw pcr assay.200818406018
prevalence of asymptomatic tropheryma whipplei carriage among humans and nonhuman primates.the reservoir of the agent of whipple disease is unknown. asymptomatic carriage of tropheryma whipplei in human stool and saliva is controversial.200818419351
cardiac complications in whipple's disease.whipple's disease or intestinal lipodystrophy is an infection induced by tropheryma whipplei. it is rare with an estimated incidence of 0.4 per million. symptoms are arthropathy, weight loss, and diarrhoea, but other organs notably the central nervous system may be affected. we demonstrate a case of cardiac complications in whipple's disease. the patient presented with endocardial infiltrations on tee examinations and heart failure and improved after antibiotic treatment.200818490346
acquired resistance to trimethoprim-sulfamethoxazole during whipple disease and expression of the causative target gene.whipple disease is a chronic infection caused by tropheryma whipplei. trimethoprim-sulfamethoxazole is recommended for treatment of whipple disease but is associated with treatment failure. t. whipplei is resistant in vitro to trimethoprim, because the gene targeted by this agent is missing.200818500934
high prevalence of fastidious bacteria in 1520 cases of uveitis of unknown etiology.the etiologic evaluation of uveitis is frequently unsuccessful when noninvasive methods are used. we conducted a prospective study to evaluate systematic screening for pathogens of uveitis. all patients with uveitis referred to the participating tertiary ophthalmology departments from january 2001 to september 2007 underwent intraocular and serum specimen collection. the standardized protocol for laboratory investigations included universal polymerase chain reaction (pcr)-based detection of any ...200818520326
[reminiscences on the occasion of the whipple's disease centenary: a summary paper].the disease referred to eponymically as whipple's disease (wd) in medical literature was thoroughly described by the american physician and pathologist george hoyot whipple (1878-1976) in 1907 and given a temporary denomination of "intestinal lipodystrophy". according to literature, wd is rare, but its precise incidence has not yet been established. familial incidence of the disease is acknowledged, and its immunogenetic pathogenesis is assumed. the incidence ofwd is prevailingly observed in mid ...200818522299
neurological presentation of whipple's disease after long-term antibiotic treatment: a case report.whipple's disease is a rare systemic infectious disorder caused by tropheryma whipplei.200818522718
whipple's disease-generalized stage.whipple's disease is a chronic inflammatory systemic disorder in which all organs can be invaded by the rod-shaped bacterium tropheryma whipplei. it is a rare disease and frequently misdiagnosed, though there is no valid estimate of its actual incidence and prevalence. only about 1,000-1,500 cases have been reported. the clinical course of untreated whipple's disease can include three stages: (1) a non-specific prodromal stage which includes migratory polyarthralgias; (2) a classic abdominal man ...200818523887
[refractory intermediate uveitis in the presence of unexplained joint disease. diagnosis: tropheryma whipplei (morbus whipple)]. 200817522867
[macrophagic myofascitis vs atypical whipple's disease].a 39-year-old man presented pronounced asthenia and diffuse myalgias 8 months after a vaccination against the tetanus toxoid. muscle biopsy disclosed infiltration of the perimysium and endomysium by densely packed, pas-positive macrophages. tropheryma whippelii detection in blood and faeces allowed the initial assumption of atypical whipple's disease with isolated muscle involvement. however, the histological detection of aluminium-containing macrophages by means of morin stain immunofluorescenc ...200818726082
whipple's disease: neurological relapse presenting as headache for two years.whipple's disease is a rare, chronic, multi-systemic infectious disorder caused by the bacterium, tropheryma whipplei. relapses are commonly associated with neurological symptoms. we report a case of a 55-year-old man who presented with symptoms of progressive headache, 13 years after apparent complete recovery from intestinal whipple's disease. studies showed hydrocephalus with obstruction of the aqueduct and cerebrospinal fluid findings consistent with chronic meningitis. diagnosis of central ...200818784966
diagnosis and management of whipple's disease of the brain.whipple's disease of the brain is one of the most challenging neurological diagnoses. "is it whipple's disease?" is a frequent question, but rarely is the answer yes. the neurological manifestations do not help to distinguish primary from secondary whipple's disease of the brain, and although mr brain scanning with gadolinium is mandatory, it can be normal and any abnormalities are non-specific. there must be a comprehensive search for multisystem involvement such as raised inflammatory markers, ...200818796586
whipple's disease: easily diagnosed, if considered.patients present with arthralgia, abdominal pain, diarrhoea and weight loss. the disease is commonly diagnosed by histological examination of small bowel biopsies, especially after staining with periodic acid-schiff. because of the rarity of the disease, its diagnosis is not often considered. therefore the necessary investigations might be omitted. this case report might serve as a reminder for internists or gastroenterologists to consider whipple's disease in patients with abdominal, articular ...200818931401
[microbiological diagnosis of emerging bacterial pathogens: anaplasma, bartonella, rickettsia, and tropheryma whipplei].ehrlichia/anaplasma, bartonella, rickettsia and tropheryma whipplei (formerly called whippelii) are fastidious bacterial organisms, considered the causative agents of potentially severe emerging and re-emerging diseases with repercussions on public health. the recent availability of advanced molecular biology and cell culture techniques has led to the implication of many of these species in human pathologies. these issues are extensively covered in number 27 of the seimc microbiological procedur ...200819100178
an immunoproteomic approach for identification of clinical biomarkers of whipple's disease.whipple's disease (wd) is a chronic multisystemic infection, caused by the bacterium tropheryma whipplei. the main clinical presentations are classic wd (cwd) with histologic lesions in the gastrointestinal tract, endocarditis, and isolated neurologic infection. the current strategy for diagnosis remains invasive.the present study aimed to select the protein candidates for serological diagnosis of wd. the first step was to identify candidate proteins by an immunoproteomic approach combining 2-de ...200821136854
false positive pcr detection of tropheryma whipplei in the saliva of healthy people.tropheryma whipplei, the agent of whipple's disease (wd), has been recently isolated and the genomes of two isolates have been fully sequenced. previous diagnosis tools for the diagnosis of the disease used sequence analysis of the 16s rrna gene. using this target gene, the high percentage of detection of the bacterium in saliva of healthy people was in contrast to the negative results obtained with specific target genes. the aim of our study was to compare previously published primers targeting ...200717535423
increased levels of circulating il-16 and apoptosis markers are related to the activity of whipple's disease.whipple's disease (wd) is an infectious disease caused by tropheryma whipplei, which replicates in macrophages and induces the release of interleukin (il)-16, a substrate of caspase 3, and macrophage apoptosis. the disease is characterized by intestinal, cardiac or neurological manifestations; its diagnosis is based on invasive analysis requiring tissue biopsies or cerebrospinal fluid puncture. the disease progression is slow and often complicated by relapses despite empirical antibiotic treatme ...200717551575
[whipple's disease: current problems].whipple's disease is a rare multisystemic infectious disease of bacterial origin characterized by variable clinical manifestations, and an insidious and chronic relapsing course. untreated disease can be even fatal. the presence of the characteristic (though not specific) triad of weight loss, chronic diarrhea and arthralgias may raise its suspicion. when chronic intermittent fever and lymphadenopathy are associated, the suspicion is substantial. recognition of the causative agent, tropheryma wh ...200717588856
ultrastructural evidence of tropheryma whippelii in pas-negative granulomatous lymph nodes.the presence of tropheryma whippelii was demonstrated in the pas-negative mesenteric granulomatous lymph nodes of a patient affected by whipple disease. ultrastructurally a few bacteria, enclosed by a membrane characteristic of tropheryma whippelii, were found in the extracellular spaces and remnants of bacteria were found in the phagocytic vacuoles of macrophages. the scarce number of bacilli, probably due to the fact that the disease was at an initial phase, could explain the absence of pas po ...200717613996
therapy for whipple's disease.whipple's disease was first described in 1907, the genomic composition of the causative organism, tropheryma whipplei, was unravelled in 2003 and its in vitro susceptibility to antibiotics started to be explored in 2004-05. still today, this knowledge is not fully applied in the recommendations for the therapy of this disease. in this paper, we summarize the current recommendations on antimicrobial therapy for whipple's disease and propose a shift in the maintenance therapy.200717623695
recycling of chloroquine and its hydroxyl analogue to face bacterial, fungal and viral infections in the 21st century.chloroquine (cq) and its hydroxyl analogue hydroxychloroquine (hcq) are weak bases with a half-century long use as antimalarial agents. apart from this antimalarial activity, cq and hcq have gained interest in the field of other infectious diseases. one of the most interesting mechanisms of action is that cq leads to alkalinisation of acid vesicles that inhibit the growth of several intracellular bacteria and fungi. the proof of concept of this effect was first used to restore intracellular ph a ...200717629679
molecular diagnosis of infective endocarditis by real-time broad-range polymerase chain reaction (pcr) and sequencing directly from heart valve tissue.traditionally, infective endocarditis (ie) has been microbiologically diagnosed by blood cultures or serology. however, conventional microbiologic methods do not always provide an etiologic diagnosis. we conducted the current study to evaluate the usefulness of a universal real-time polymerase chain reaction (pcr) of the 16s rrna gene followed by sequencing for the diagnosis of ie in explanted heart valve tissue (hv) as part of the routine of a clinical microbiology laboratory, and to compare it ...200717632260
[tonsillar hypertrophy and mesenteric adenopathies as the main manifestations in a patient with whipple's disease].whipple's disease is an infrequent chronic infection caused by tropheryma whipplei, identified in 1992. intestinal, articular, central nervous system and cardiac involvement is common. the presence of abdominal adenopathies, especially mesenteric adenopathies, without peripheral adenopathies or gastrointestinal, articular, neurological or cardiac symptoms is rare. we present the case of a male patient with tonsillar hypertrophy, mesenteric adenopathies, fever and constitutional syndrome, leading ...200717692197
whipple disease revealed by musculocutaneous symptoms, with muscle biopsy cultures positive for tropheryma whipplei.a patient experienced sudden onset of musculocutaneous symptoms 3 years after being diagnosed with polyarthritis. biopsies from the duodenum, skin, and muscle established the diagnosis of whipple disease. cultures of muscle biopsy specimens grew tropheryma whipplei. adequate antibiotic therapy ensured a favorable outcome. to our knowledge, this is the first case in which t. whipplei was recovered from muscle biopsy specimens, confirming the infectious nature of muscle involvement in whipple dise ...200717900961
comparative genomic analysis of tropheryma whipplei strains reveals that diversity among clinical isolates is mainly related to the wisp proteins.the aim of this study was to analyze the genomic diversity of several tropheryma whipplei strains by microarray-based comparative genomic hybridization. fifteen clinical isolates originating from biopsy samples recovered from different countries were compared with the t. whipplei twist strain. for each isolate, the genes were defined as either present or absent/divergent using the gack analysis software. genomic changes were then further characterized by pcr and sequencing.200717910761
[whipple's disease].for many years, whipple's disease was considered a rare, mainly intestinal disease causing malabsorption. at present, however, it appears to be multivisceral mainly occuring in subjects with specific and subtle cell-mediated immunity defects. until recently, diagnosis and follow-up of treatment efficacy depended on pas positive macrophage inclusions in duodenal biopsies. new diagnostic methods based on pcr gene amplification and immunohistochemistry are now available by dna sequencing and cultur ...200717925777
[aortic and mitral valve infective endocarditis caused by tropheryma whipplei and with no gastrointestinal manifestations of whipple's disease].a case of blood culture-negative aortic and mitral valve infective endocarditis caused by the bacterium tropheryma whipplei is reported. a 33-year-old man showed no clinical manifestations of whipple's disease, with the exception of arthralgia as given in his history. the disease was complicated by recurrent cerebral and left upper limb embolization of vegetations. the causative agent was detected in a valve sample using broad-range polymerase chain reaction. the patient underwent successful sur ...200717987571
orbital manifestation of whipple's disease: an atypical case.whipple's disease is a systemic disorder caused by an infection with a gram-positive bacillus, tropheryma whipplei. almost every organ system can be affected in whipple's disease, resulting in varying clinical symptoms.200718029189
advances in tropheryma whipplei research: the rush to find biomarkers for whipple's disease.whipple's disease (wd) is a systemic chronic infection, caused by the gram-positive bacterium tropheryma whipplei. there are several clinical traits linked to wd: histological lesions in the gi tract in association with diverse clinical manifestations (classic wd), endocarditis with negative blood cultures, and isolated neurological infection. wd is rare, predominantly affects middle-aged men and is fatal without treatment. the most recent strategy for diagnosing wd uses the results of diastase- ...200718041904
molecular identification of bacteria in bronchoalveolar lavage fluid from children with cystic fibrosis.culture of bronchoalveolar lavage fluid (balf) is the gold standard for detection of pathogens in the lower airways in cystic fibrosis (cf). however, current culture results do not explain all clinical observations in cf, including negative culture results during pulmonary exacerbation and inflammation in the absence of pathogens. we hypothesize that organisms not routinely identified by culture occur in the cf airway and may contribute to disease. to test this hypothesis we used a culture-indep ...200718077362
premature ovarian failure in suspected whipple's disease.whipple's disease is a relapsing systemic infectious disease probably caused by the gram-positive bacillus tropheryma whippelii. the diagnosis can be established based on the characteristic histopathological features found in the affected organ (foamy macrophages with a coarsely granular cytoplasm, which stains with pas, and by means of polymerase chain reaction (pcr) technology).200718078849
the prevalence of tropheryma whippelii dna in saliva from healthy controls and patients with spondyloarthropathy. 200717013607
[whipple's disease].whipple's disease is a rare infectious disorder affecting mostly middle aged men. the causative organism, tropheryma whipplei, recently has been cultivated and phylogenetically identified as an actinomycete. the rareness of the disease despite the ubiquitous occurence of t. whipplei presumably is related to a predisposing defect in cellular immunity. the diagnosis usually can be established by small bowel biopsy, but is frequently delayed due to protean clinical manifestations. the initiation of ...200717256556
tropheryma whipplei in the environment: survey of sewage plant influxes and sewage plant workers.we studied the prevalence of tropheryma whipplei in influxes to 46 sewage treatment plants and in stool, mouthwash fluids, and dental plaques of 64 healthy workers in those facilities and 146 disease control patients. t. whipplei was found in sewage water, in stool of healthy individuals, and significantly more often in stool of workers exposed to sewage water.200717277223
molecular basis of tropheryma whipplei doxycycline susceptibility examined by transcriptional profiling.tropheryma whipplei is a poorly studied bacterium responsible for whipple's disease. in this study, its susceptibility to doxycycline was investigated at a transcriptional level using a whole-genome dna microarray.200717289769
a patient with cerebral whipple disease with gastric involvement but no gastrointestinal symptoms: a consequence of local protective immunity?whipple disease is a granulomatous infectious disease caused by tropheryma whipplei. the bacteria accumulate within macrophages, preferentially in the intestinal mucosa. disease manifestation seems to be linked to immunological abnormalities of macrophages. we describe a patient with cerebral whipple disease who presented with changes in mental status, confusion, inverse sleep-wake cycle, bilateral ptosis and vertical gaze palsy. endoscopic biopsy sampling revealed whipple disease in the gastric ...200717371903
eosinophilic vasculitis: a rare presentation of whipple's disease.whipple's disease is a multisystem infectious disease caused by the bacterium tropheryma whippelii. a case with an unusual presentation is reported. a 66-year-old man presented with a febrile vasculitic rash on his forearms. an extensive rheumatological, hematological and infectious workup gave negative results, apart from mild anemia and eosinophilia. an abdominal computed tomography revealed a retroperitoneal lymphadenopathy, and a skin biopsy revealed an eosinophilic vasculitis. this diverted ...200717377649
tropheryma whipplei infective endocarditis as the only manifestation of whipple's disease.here we describe a case of infective endocarditis caused by tropheryma whipplei in a patient with no other symptoms of whipple's disease. the case was diagnosed using broad-range pcr and confirmed by specific pcrs. we review the cases of infective endocarditis presenting as the only manifestation of whipple's disease reported in the literature.200717446327
cultivation of tropheryma whipplei from the synovial fluid in whipple's arthritis.this report describes a patient who presented with fever, weight loss, diarrhea, and adenopathy. at the time of presentation he had a 28-year history of unusually severe destructive polyarthritis. duodenal biopsy revealed periodic acid-schiff-positive macrophages. polymerase chain reaction studies showed positivity for tropheryma whipplei in synovial fluid, synovial tissue, and lymph node specimens, and whipple's disease was diagnosed. t whipplei was successfully cultivated from the synovial flu ...200717469186
hypersomnia in whipple disease: case report.whipple disease (wd) is a rare systemic infection caused by tropheryma whippelii. neurological involvement has been recognised in 40% of patients, either as initial manifestations or during the course of the disease. we report on a 45 years-old man with wd with initial, persistent and irresistible episodes of daytime somnolence. the patient was hla-dqb1*0602 positive (genetic marker for narcolepsy). wd diagnosis was suspected on clinical and mri basis and confirmed by histological and immunohist ...200617057900
current concepts of immunopathogenesis, diagnosis and therapy in whipple's disease.whipple's disease (wd) is a rare chronic infectious disorder caused by the rod- shaped bacterium tropheryma whipplei. the disorder is characterized clinically by arthralgia, abdominal pain, diarrhea, malabsorbtion and progressive weight loss. other important sites of infection include the heart (resulting in the clinical picture of endocarditis and heart failure) and the central nervous system (cns) (manifestations include confusion, memory loss, focal cranial nerve signs, nystagmus and ophtalmo ...200617073638
[scurvy and acquired ichthyosis associated to whipple's disease].the skin manifestations, except for hyperpigmentation, are uncommon in whipple's disease (wd). we present the case of a 48-year-old male with chronic diarrhea and long course general syndrome associated to neurological manifestations. skin examination revealed lesions in the lower limbs and gums that were clinically consistent with scurvy and were confirmed by histological study and measurement of blood vitamin c levels. furthermore, he had lesions that were clinically and histologically consist ...200617173764
decision analysis: an aid to the diagnosis of whipple's disease.diagnosis of whipple's disease, a rare systemic infection affecting predominantly the small bowel, is based on the identification of the bacterium tropheryma whipplei.200616556186
evolutionary constraints on codon and amino acid usage in two strains of human pathogenic actinobacteria tropheryma whipplei.the factors governing codon and amino acid usages in the predicted protein-coding sequences of tropheryma whipplei tw08/27 and twist genomes have been analyzed. multivariate analysis identifies the replicational-transcriptional selection coupled with dna strand-specific asymmetric mutational bias as a major driving force behind the significant interstrand variations in synonymous codon usage patterns in t. whipplei genes, while a residual intrastrand synonymous codon bias is imparted by a select ...200616557339
identification of candidate antigen in whipple's disease using a serological proteomic approach.whipple's disease (wd) is a chronic multisystemic infection, caused by tropheryma whipplei, a gram-positive rod. recently, a reliable method has been developed for cultivating t. whipplei in vitro. this together with the availability of complete genome sequence of t. whipplei prompted us to initiate proteome analysis of t. whipplei. the objective of the present study was to identify candidate proteins for serological diagnosis of wd. immunoreactivities of sera collected from 18 patients with wd ...200616637011
autoimmunohistochemistry: a new method for the histologic diagnosis of infective endocarditis.although the pathologic examination of cardiac valves remains the reference standard for the diagnosis of infective endocarditis, the detection of microorganisms often poses a challenge for pathologists. this can be done by use of nonspecific histochemical stains or by immunohistochemical analysis, but specific antibodies are often not available. we describe a novel method for the detection of microorganisms in valve specimens from patients with infective endocarditis.200616703515
tropical sprue in two foreign residents, with evidence of tropheryma whippelii in one case.tropical sprue is a rare disease in travelers. its etiology remains unclear. we report two cases of tropical sprue occurring in long-term residents in nepal and cameroon. in one case, tropheryma whippelii, the agent of whipple's disease, was identified. many infectious agents have been suggested to be the etiological agent of tropical sprue, but no association with whipple's disease has yet been reported.200616706950
global transcriptome analysis of tropheryma whipplei in response to temperature stresses.tropheryma whipplei, the agent responsible for whipple disease, is a poorly known pathogen suspected to have an environmental origin. the availability of the sequence of the 0.92-mb genome of this organism made a global gene expression analysis in response to thermal stresses feasible, which resulted in unique transcription profiles. a few genes were differentially transcribed after 15 min of exposure at 43 degrees c. the effects observed included up-regulation of the dnak regulon, which is comp ...200616816195
neurologic manifestations of whipple's disease.whipple's disease is a rare, multisystem, infectious disorder caused by the bacterium tropheryma whippelii. patients with central nervous system (cns) involvement may present in a variety of ways, including cognitive impairment, psychiatric manifestations, gaze palsies, upper motor neuron signs, and hypothalamic dysfunction. a tissue-based diagnosis of whipple's disease is made based on the presence of periodic acid-schiff-stained material or by the identification of bacterial rna using polymera ...200616822374
reduced peripheral and mucosal tropheryma whipplei-specific th1 response in patients with whipple's disease.whipple's disease is a rare infectious disorder caused by tropheryma whipplei. major symptoms are arthropathy, weight loss, and diarrhea, but the cns and other organs may be affected, too. the incidence of whipple's disease is very low despite the ubiquitous presence of t. whipplei in the environment. therefore, it has been suggested that host factors indicated by immune deficiencies are responsible for the development of whipple's disease. however, t. whipplei-specific t cell responses could no ...200616849516
murine model of infection by tropheryma whipplei.we developed an animal model reproducing several aspects of whipple's disease. immunocompetent mice were persistently infected with tropheryma whipplei, its etiological agent, and developed liver granulomas. scid mice were infected similarly but did not develop tissue lesions. the delayed clearance of t. whipplei suggests a protective role for innate immunity.200616861681
primary whipple's disease of the brain: characterization of the clinical syndrome and molecular diagnosis.whipple's disease (wd) of the brain without evidence of systemic involvement is a rare illness that is difficult to recognize and potentially life-threatening.200616905752
whipple's disease with muscle impairment.a 67-year-old man presented with myalgia, muscle atrophy, and a history of seronegative polyarthritis. blood tests showed inflammation but no hematologic or immunologic abnormalities. muscle biopsy revealed no vasculitis or myositis but tropheryma whipplei was detected by polymerase chain reaction in muscle, blood, and duodenum specimens; this was confirmed by immunohistochemistry. ceftriaxone led to clinical improvement. although rare, whipple's disease should be considered in the differential ...200616967496
production of monoclonal antibodies to tropheryma whipplei and identification of recognized epitopes by two-dimensional electrophoresis and mass spectrometry.tropheryma whipplei, the agent of whipple's disease, is a gram-positive rod-shaped bacterium that belongs to the group of actinobacteria. in order to produce monoclonal antibodies (mabs) against this bacterium, we inoculated mice with two different strains, slow2 and endo5. we produced 13 and 10 mabs against slow2 and endo5, respectively. nine of the slow2 mabs and seven of the endo5 mabs recognized a 58-kda epitope. in addition, three other endo5 mabs detected a unique 84-kda epitope. these mab ...200616988020
metagrowth: a new resource for the building of metabolic hypotheses in microbiology.metagrowth is a new type of knowledge base developed to guide the experimental studies of culture conditions of obligate parasitic bacteria. we have gathered biological evidences giving possible clues to the development of the axenic (i.e. 'cell-free') growth of obligate parasites from various sources including published literature, genomic sequence information, metabolic databases and transporter databases. the database entries are composed of those evidences and specific hypotheses derived fro ...200515608207
whipple disease: intestinal infiltrating cells exhibit a transcriptional pattern of m2/alternatively activated macrophages.whipple disease (wd) is a rare systemic disease caused by tropheryma whipplei and is characterized by the presence of foamy macrophages with periodic acid-schiff-positive inclusions in tissues such as lamina propria. for the first time, we report the gene-expression profile of macrophages in intestinal lesions from a patient with wd. microarray and real-time polymerase chain reaction revealed that genes encoding ccl18, cathepsins, scavenger receptor, interleukin-10, and lipid metabolites were up ...200516206080
[whipple disease and central nervous system].whipple disease (wd) is a rare systemic infection caused by the bacteria tropheryma whipplei. slowly progressive dementia, supranuclear ophthalmoplegia, headache, myoclonus, hypothalamic dysfunction, oculomasticatory-skeletal myorythmia are characteristic manifestations when wd involves the central nervous system (cns). treatment of cerebral wd should be performed with antibiotics that reach the cns for at the least one-year. we alert for the early diagnosis of wd in patients with exclusively ne ...200516207456
intervening sequence acquired by lateral gene transfer in tropheryma whipplei results in 23s rrna fragmentation.completion of tropheryma whipplei genome sequencing may provide insights into the evolution of the molecular mechanisms underlying the pathogenicity of this microorganism. the first postgenomic application was the successful design of a comprehensive culture medium that allows axenic growth of this bacterium, which is particularly recalcitrant to cultivation. this achievement in turn permitted analysis of t. whipplei rna without contaminating eukaryotic nucleic acids. to obtain high-quality rna, ...200516269699
[whipple disease, initially diagnosed as sarcoidosis].whipple disease is a multisystem infectious disease caused by tropheryma whipplei. we report a case in which an initial diagnosis of sarcoidosis was changed to whipple disease endocarditis.200516301965
molecular evaluation of antibiotic susceptibility of tropheryma whipplei in axenic medium.whipple's disease is a rare multisystem chronic infection, involving the intestinal tract as well as various other organs. tropheryma whipplei is a slow-growing facultative intracellular bacterium that remains poorly understood. in vitro antibiotic susceptibility testing has previously been assessed in cells using a real-time quantitative pcr assay. in this study, we have evaluated the antibiotic susceptibility of three strains of t. whipplei grown in axenic medium using the same assay.200515650004
deadly carousel or difficult interpretation of new diagnostic tools for whipple's disease: case report and review of the literature.whipple's disease is a rare systemic disorder classically presenting with weight loss, arthralgias, and diarrhea, which was first described in 1907. the causative bacterium tropheryma whipplei, is a fastidious organism not growing on conventional media. before the introduction of polymerase chain reaction (pcr)-based methods, the diagnostic gold standard was histological detection of diastase-resistant periodic acid schiff (pas)-positive macrophages or electron microscopy. as in the present case ...200515750760
[weight loss, renal insufficiency, aortal stenosis and arthralgias].the 68-year-old male patient complained of weight loss and -- since 15 years -- of arthralgias and had renal insufficiency and an aortic stenosis. despite the lack of intestinal symptoms, m. whipple could be diagnosed, being responsible for his symptoms and clinical signs. under antibiotic and supportive treatment the patient recovered uneventfully.whipple's disease, otherwise known as intestinal lipodystrophy, is a disease with various signs and symptoms. the principal signs are rheumatic compl ...200515772857
cerebral whipple's disease as a cause of reversible dementia.we describe a case of reversible dementia caused by tropheryma whippelii (tw). diagnosis was confirmed by a positive polymerase chain reaction for this pathogen both on serum and cerebrospinal fluid. specific antibiotic therapy resulted in distinct clinical and neuroradiological improvement. control polymerase chain reaction for t. whippelii on serum and cerebrospinal fluid was negative.200515823686
immunosuppressive therapy in whipple's disease patients is associated with the appearance of gastrointestinal manifestations.whipple's disease is a rare chronic disorder, which is caused by systemic infection with tropheryma whipplei. the first symptom of whipple's disease usually is a nondestructive polyarthritis resembling in many aspects seronegative rheumatoid arthritis. this polyarticular inflammatory arthropathy preceding the diagnosis of whipple's disease for several years frequently is treated with nonsteroidal antiinflammatory drugs (nsaids) and with immunosuppressive therapy. there is evidence that altered i ...200515842595
blood culture-negative endocarditis in a reference center: etiologic diagnosis of 348 cases.to identify the current etiologies of blood culture-negative infective endocarditis and to describe the epidemiologic, clinical, laboratory, and echocardiographic characteristics associated with each etiology, as well as with unexplained cases, we tested samples from 348 patients suspected of having blood culture-negative infective endocarditis in our diagnostic center, the french national reference center for rickettsial diseases, between 1983 and 2001. serology tests for coxiella burnettii, ba ...200515879906
whipple disease: a case report and review of the literature.whipple disease is a chronic, relapsing, and multisystem disease. it presents a diagnostic challenge for both clinicians and pathologists. recent advances in isolation and culture have identified the organism responsible for the disease to be a member of the order actinomycetes designated tropheryma whipplei. several immune system changes have been noted in patients with whipple disease, but whether these are primary or secondary is as yet undetermined. long-term antibiotic therapy is required, ...200515974820
detection of tropheryma whipplei dna in clinical specimens by lightcycler real-time pcr.a real-time pcr method using the lightcycler (roche applied science, indianapolis, in) was compared to a conventional pcr assay for the detection of tropheryma whipplei in 321 clinical specimens. the lightcycler method had sensitivity and specificity comparable to the conventional method but required considerably less labor and time (3 h versus 3 to 5 days).200516000494
[whipple's disease. two new cases of an underdiagnosed disease].whipple's disease is a rare systemic infectious disease caused by the bacterium tropheryma whippelii. early diagnosis is essential. whipple's disease is potentially fatal but responds dramatically to antibiotic treatment. the diagnosis is confirmed by means of polymerase chain reaction (pcr) technology. this analysis may be useful for monitoring the efficacy of therapy. the recommended treatment al present is administration of cotrimoxazole twice daily for one year. when cns involvement occurs, ...200516001939
a patient with cerebral whipple's disease and a stroke-like syndrome.the central nervous system (cns) may be affected in up to 50% of patients with whipple's disease and this can occur even with little or no gastrointestinal involvement. we describe a 63-year-old patient in whom cns involvement with whipple's disease had the clinical and imaging features of a brain infarction. treatment with aspirin and ceftriaxone followed by trimethoprim-sulfamethoxazole resulted in a good neurological recovery and complete remission of the malabsorption syndrome. cerebral whip ...200516036516
whipple's disease: multiple hospital admissions of a man with diarrhoea, fever and arthralgia.whipple's disease is a rare chronic multi-systemic infectious disorder caused by the gram-positive bacillus, tropheryma whippelii. infection may involve any organ in the body, and most commonly affects white men in the fourth to sixth decades of life. the most common presenting symptoms are gastrointestinal and include abdominal pain, diarrhoea, anorexia and associated weight loss. however, the variability in presentation is considerable and some patients may present with intermittent low-grade ...200516038747
an unusual case of insomnia associated with whipple encephalopathy: first case reported from greece.whipple disease is a relapsing systemic illness caused by tropheryma whippelii. central nervous system involvement occurs in 5%-40% of all patients. hypothalamic manifestations occur in 31% of whipple encephalopathy, including polydipsia, hyperphagia, change in libido and insomnia. we report a case of a 48-year-old man with severe insomnia, depression, dementia, dysarthria, myoclonic movements of the limbs and ophthalmoplegia. the diagnosis of whipple encephalopathy was confirmed by pcr analysis ...200516086132
exacerbation of whipple's disease associated with infliximab treatment.a 34-year-old man with chronic inflammatory joint disease and recurrent fever over 6 years was diagnosed as having still's disease. treatment with corticosteroids and azathioprine was ineffective. therefore, infliximab/ methotrexate was started. the patient subsequently developed a wasting disease with rapid weight loss, erythema nodosum, diarrhoea, progressive lymph node enlargement, and a sigmoido-vesical fistula. histological analysis of several enlarged lymph nodes, the margins of the fistul ...200516095013
[whipple's disease endocarditis: report of 5 cases and review of the literature].endocarditic lesions (infectious endocarditis) associated with whipple's disease are exceptional. we report five cases from the cardiovascular and pneumologic hospital louis pradel in lyon.200516146664
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