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Chapter 11 : Whipple’s Disease

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Whipple’s Disease, Page 1 of 2

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Abstract:

Whipple’s disease (WD) is a rare multisystemic chronic infection caused by the rod-shaped bacterium . Patients usually present with symptoms of weight loss, arthralgia, diarrhea, and abdominal pain. Involvement of the heart, lung, and central nervous system (CNS) is also common. The diagnosis is established by small-bowel biopsy in which the samples show inclusions in macrophages of the lamina propria staining with periodic acid-Schiff (PAS). The inclusions present remnants of the causative organism . Phylogenetic analysis of the 16S rRNA gene sequence established that this bacterium is an actinomycete. In patients already infected with , immunosuppression accelerates the course of the infection and especially triggers the occurrence of intestinal manifestations. Neurologic manifestations occur in three situations: neurologic involvement in classic WD, isolated neurologic symptoms due to infection without histologic evidence of intestinal involvement, and neurologic relapse of previously treated WD. The pathogenesis of cerebral infarction is not well established, but cerebral vasculitis, arterial fibrosis, thrombosis, and thickening associated with the inflammation of adjacent brain parenchyma and leptomeninges, caused by the hematogenous spread of to the brain, may all be important triggers. Immunohistochemical staining for antibodies against can detect the organism in various tissues, body fluids, and blood monocytes. Therapeutic recommendations are empirically based or based on in vitro susceptibility tests. Due to the rarity of the disorder, cooperative studies and clinical trials are necessary to clarify the unanswered questions and to establish evidence-based therapeutic recommendations.

Citation: Marth T, Deriban G. 2009. Whipple’s Disease, p 205-216. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch11

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Immune Systems
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Gastrointestinal Diseases
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Humoral Immune Response
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Magnetic Resonance Imaging
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16s rRNA Sequencing
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Citation: Marth T, Deriban G. 2009. Whipple’s Disease, p 205-216. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch11
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References

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1. Akar, Z.,, N. Tanriover, and, S. Tuzgen. 2002. Intracerebral Whipple disease: unusual location and bone destruction. J. Neurosurg. 97:988991.
2. Altwegg, M.,, A. Fleisch-Marx,, D. Goldenberger,, S. Hailemariam,, A. Schaffner, and, R. Kissling. 1996. Spondylodiscitis caused by Tropheryma whippelii. Schweiz. Med. Wochenschr. 35:14951499.
3. Amsler, L.,, P. Bauernfeind,, C. Nigg,, R. C. Maibach,, R. Steffen, and, M. Altwegg. 2003. Prevalence of T. whipplei DNA in patients with various gastrointestinal diseases and in healthy controls. Infection 31:8185.
4. Apperly, F. L.,, and E. L. Copley. 1943. Whipple’s disease (lipophagia granulomatosis). Gastroenterology 1:461470.
5. Autran, B.,, I. Gorin,, M. Leibowitch,, L. Laroche,, J. P. Escande,, J. Hewitt, and, C. Marche. 1983. AIDS in a Haitian woman with cardiac Kaposi’s sarcoma and Whipple’s disease. Lancet i:767768.
6. Ayoub, W. T.,, D. E. David,, D. Torretti, and, F. J. Viozzi. 1982. Bone destruction and ankylosis in Whipple’s disease. J. Rheumatol. 9:930931.
7. Bai, J. C.,, A. H. Mota,, E. Mauriño,, S. Niveloni,, F. Grossman,, L. A. Boerr, and, L. Fainboim. 1991. Class I and class II HLA antigens in a homogeneous Argentinian population with Whipple’s disease: lack of association with HLA-B 27. Am. J. Gastroenterol. 86:992994.
8. Baisden, B. L.,, H. Lepidi,, D. Raoult,, P. Argani,, J. H. Yardley, and, J. S. Dumler. 2002. Diagnosis of Whipple disease by immunohistochemical analysis: a sensitive and specific method for the detection of T. whipplei (the Whipple bacillus) in paraffin-embedded tissue. Am. J. Clin. Pathol. 118:742748.
9. Barbaryka, I.,, L. Thorn, and, E. Langer. 1979. Epithelioid cell granulomata in the mucosa of the small intestine in Whipple’s disease. Virchows Arch. A 382:227235.
10. Bassotti, G.,, M. A. Pelli,, R. Ribacchi,, M. Miglietti,, M. L. Cavalletti,, M. E. Rossodivita,, P. Giovenali, and, A. Morelli. 1991. Giardia lamblia infestation reveals underlying Whipple’s disease in a patient with longstanding constipation. Am. J. Gastroenterol. 86:371374.
11. Benoit, M.,, F. Fenollar,, D. Raoult, and, J. L. Mege. 2007. Increased levels of circulating IL-16 and apoptosis markers are related to the activity of Whipple’s disease. PLoS ONE 6:e494.
12. Boulos, A.,, J. M. Rolain,, M. N. Mallet, and, D. Raoult. 2005. Molecular evaluation of antibiotic susceptibility of Tropheryma whipplei in axenic medium. J. Antimicrob. Chemother. 55:178181.
13. Boulos, A.,, J. M. Rolain, and, D. Raoult. 2004. Antibiotic susceptibility of Tropheryma whipplei in MRC5 cells. Antimicrob. Agents Chemother. 48:74752.
14. Brouqui, P.,, H. Tissot-Dupont, and, M. Drancourt. 1993. Chronic Q fever: ninety-two cases from France, including 27 cases without endocarditis. Arch. Intern. Med. 153:642648.
15. Cannon, W. R. 2003. Whipple’s disease, genomics, and drug therapy. Lancet 361:1916.
16. Célard, M.,, G. de Gevigney, and, S. Mosnier. 1999. Polymerase chain reaction analysis for diagnosis of Tropheryma whippelii infective endocarditis in two patients with no previous evidence of Whipple’s disease. Clin. Infect. Dis. 29:13481349.
17. Chears, W. C.,, and C. T. Ashworth. 1961. Electron microscopy study of the intestinal mucosa in Whipple’s disease–demonstration of encapsulated bacilliform bodies in the lesion. Gastroenterology 41:129138.
18. Chears, W. C.,, M. D. Hargrove,, J. V. Verner,, A. G. Smith, and, J. M. Ruffin. 1961. Whipple’s disease; a review of twelve patients from one service. Am. J. Med. 30:226234.
19. Cho, C.,, W. G. Linscheer,, M. A. Hirschkorn, and, K. Ashutosh. 1984. Sarcoidlike granulomas as an early manifestation of Whipple’s disease. Gastroenterology 87:941947.
20. Cohen, A. S.,, E. M. Schimmel,, P. R. Holt, and, K. J. Isselbacher. 1960. Ultrastructural abnormalities in Whipple’s disease. Proc. Soc. Exp. Biol. Med. 105:411414.
21. Coria, F.,, N. Cuadrado, and, C. Velasco. 2000. Whipple’s disease with isolated central nervous system symptomatology diagnosed by molecular identification of Tropheryma whippelii in peripheral blood. Neurologia 15:173176.
22. Desnues, B.,, M. Ihrig,, D. Raoult, and, J. L Mege. 2006. Whipple’s disease: a macrophage disease. Clin. Vaccine Immunol. 2:170178.
23. Desnues, B.,, H. Lepidi,, D. Raoult, and, J. L. Mege. 2005. Whipple disease: intestinal infiltrating cells exhibit a transcriptional pattern of M2/alternatively activated macrophages. J. Infect. Dis. 9:16421646.
24. Desnues, B.,, D. Raoult, and, J. L. Mege. 2005. IL-16 is critical for T. whipplei replication in Whipple’s disease. J. Immunol. 175:45754582.
25. Dobbins, W. O., III. 1981. Is there an immune deficit in Whipple’s disease? Dig. Dis. Sci. 26:247252.
26. Dobbins, W. O., III. 1987. Whipple’s Disease. Charles C. Thomas, Springfield, IL.
27. Dobbins, W. O.,, III., and J. M. Ruffin. 1967. A light- and electron-microscopic study of bacterial invasion in Whipple’s disease. Am. J. Pathol. 51:225242.
28. Dray, X.,, K. Vahedi,, V. Delcey,, A. Lavergne-Slove,, L. Raskine,, J. F. Bergmann, and, P. Marteau. 2007. Mycobacterium avium duodenal infection mimicking Whipple’s disease in a patient with AIDS. Endoscopy 39(Suppl. 1):E296E297.
29. Dumler, J. S.,, B. L. Baisden,, J. H. Yardley, and, D. Raoult. 2003. Immunodetection of T. whipplei in intestinal tissues from Dr. Whipple’s 1907 patient. N. Engl. J. Med. 348:14111412.
30. Durand, D. V.,, C. Lecomte,, P. Cathébras,, H. Rousset, and, P. Godeau. 1997. Whipple disease: clinical review of 52 cases. Medicine (Baltimore) 76:170184.
31. Dutly, F.,, and M. Altwegg. 2001. Whipple’s disease and “Tropheryma whippelii.” Clin. Microbiol. Rev. 14:561583.
32. Dzirlo, L.,, M. Hubner,, C. Mueller,, B. Blaha,, E. Formann,, C. Dellinger,, P. Petzelbauer,, L. Muellauer,, K. Huber,, M. Kneussl, and, M. Gschwantler. 2007. A mimic of sarcoidosis. Lancet 369:1832.
33. Eck, M.,, H. Kreipe,, D. Harmsen, and, H. K. Müller-Hermelink. 1997. Invasion and destruction of mucosal plasma cells by Tropheryma whippelii. Hum. Pathol. 28:14241428.
34. Ectors, N.,, K. Geboes,, P. Rutgeerts,, J. Delabie,, V. Desmet, and, J. Janssens. 1992. RFD7-RFD9 coexpression by macrophages points to T cell–macrophage interaction deficiency in Whipple’s disease. Gastroenterology 106:A676.
35. Enzinger, F. M.,, and E. B. Helwig. 1963. Whipple’s disease: a review of the literature and report of 15 patients. Virchows Arch. 336:238268.
36. Famularo, G.,, G. Minisola, and, C. De Simone. 2005. A patient with cerebral Whipple’s disease and a stroke-like syndrome Scand. J. Gastroenterol. 40:607609.
37. Fenollar, F.,, P. E. Fournier,, D. Raoult,, R. Gérolami,, H. Lepidi, and, C. Poyart. 2002. Quantitative detection of Tropheryma whipplei DNA by real-time PCR. J. Clin. Microbiol. 3:11191120.
38. Fenollar, F.,, P. E. Fournier,, C. Robert, and, D. Raoult. 2004. Use of genome selected repeated sequences increases the sensitivity of PCR detection of Tropheryma whipplei. J. Clin. Microbiol. 42:401403.
39. Fenollar, F.,, H. Lepidi,, R. Gérolami,, M. Drancourt, and, D. Raoult. 2003. Whipple disease associated with giardiasis. J. Infect. Dis. 188:828834.
40. Fenollar, F.,, H. Lepidi, and, D. Raoult. 2001. Whipple’s endocarditis: review of the literature and comparisons with Q fever, Bartonella infection, and blood culture-positive endocarditis. Clin. Infect. Dis. 33:13091316.
41. Fenollar, F.,, X. Puechal, and, D. Raoult. 2007. Whipple’s disease. N. Engl. J. Med. 356:5566.
42. Fest, T.,, B. Pron,, M. P. Lefranc,, C. Pierre,, R. Angonin,, B. de Wazières,, Z. Soua, and, J. L. Dupond. 1996. Detection of a clonal BCL2 gene rearrangement in tissues from a patient with Whipple disease. Ann. Intern. Med. 8:738740.
43. Feurle, G. E.,, B. Doerken,, E. Schoepf, and, V. Lenhard. 1979. HLA-B27 and defects in the T-cell system in Whipples’s disease. Eur. J. Clin. Invest. 9:385389.
44. Feurle, G. E.,, M. Maiwald,, V. Moos, et al. 2007. Randomized controlled trial of antimicrobial treatment in Whipple’s disease (SIMW). Abstr. Gastroenterology 132(Suppl. S1):639.
45. Feurle, G. E.,, and T. Marth. 1994. An evaluation of antimicrobial treatment for Whipple’s disease: tetracycline versus trimethoprim-sulfomethoxazole. Dig. Dis. Sci. 39:16421648.
46. Feurle, G. E.,, B. Volk, and, R. Waldherr. 1979. Cerebral Whipple’s disease with negative jejunal histology. N. Engl. J. Med. 300:907908.
47. Fleming, J. L.,, R. H. Wiesner, and, R. G. Shorter. 1988. Whipple’s disease: clinical, biochemical and histopathological features and assessment of treatment in 29 patients. Mayo Clin. Proc. 63:539551.
48. Foreyard, A.,, C. Guglielminotti, and, P. Berthelot. 1996. Prosthetic joint infection caused by Tropheryma whippelii (Whipple’s bacillus). Clin. Infect. Dis. 22:575576.
49. Fredricks, D. N.,, and D. A. Relman. 2001. Localization of Tropheryma whippelii rRNA in tissues from patients with Whipple’s disease. J. Infect. Dis. 8:12291237.
50. Geboes, K.,, N. Ectors,, H. Heidbuchel,, P. Rutgeerts,, V. Desmet, and, G. Vantrappen. 1992. Whipple’s disease: the value of upper gastrointestinal endoscopy for the diagnosis and follow-up. Acta Gastroenterol. Belg. 2:209219.
51. Geissdörfer, W.,, I. Wittmann,, G. Seitz,, R. Cesnjevar,, M. Röllinghoff,, C. Schoerner, and, C. Bogdan. 2001. A case of aortic valve disease associated with Tropheryma whippelii infection in the absence of other signs of Whipple’s disease. Infection 29:4447.
52. Gerard, A.,, F. Sarrot-Reynauld, and, E. Liozon. 2002. Neurologic presentation of Whipple disease: report of 12 cases and review of the literature. Medicine (Baltimore) 81:443457.
53. Ghigo. E.,, C. Capo,, M. Aurouze,, J. P. Gorvel,, D. Raoult, and, J. L. Mege. 2002. The survival of Tropheryma whipplei, the agent of Whipple’s disease, requires phagosome acidification. Infect. Immun. 70:15011506.
54. Gillen, C. D.,, R. Coddington,, P. G. Monteith, and, R. H. Taylor. 1993. Extraintestinal lymphoma in association with Whipple’s disease. Gut 11:16271629.
55. Gisbertz, I. A.,, D. C. Bergmanns,, J. A. van Marion-Kievit, and, H. R. Haak. 2001. Concurrent Whipple’s disease and Giardia lamblia infection in a patient presenting with weight loss. Eur. J. Intern. Med. 12:525528.
56. Gubler, J. G.,, M. Kuster, and, F. Dutly. 1999. Whipple endocarditis without overt gastrointestinal disease: report of four cases. Ann. Intern. Med. 31:112116.
57. Groll, A.,, L. S. Valberg,, J. B. Simon,, D. Eidinger,, D. Wilson, and, D. R. Forsdyke. 1972. Immunological defect in Whipple’s disease. Gastroenterology 63:943950.
58. Gruner, U.,, P. Goesch,, A. Donner, and, U. Peters. 2001. Whipple disease and non-Hodgkin lymphoma. Z. Gastroenterol. 4:305309.
59. Hargrove, J. R.,, J. V. Verner,, A. G. Smith,, R. R. Horswell, and, J. M. Ruffin. 1960. Whipple’s disease. Report of two cases with intestinal biopsy before and after treatment. Gastroenterology 39:619622.
60. Holt, P. R.,, K. J. Isselbacher, and, C. M. Jones. 1961. The reversibility of Whipple’s disease. Report of a case, with comments on the influence of corticosteroid therapy. N. Engl. J. Med. 264:13351339.
61. Jones, C. M.,, J. A. Benson, Jr., and, A. L. Roque. 1953. Whipple’s disease; report of a case with special reference to histochemical studies of biopsy material and therapeutic results of corticosteroid therapy. N. Engl. J. Med. 16:665670.
62. Keinath, R. D.,, D. E. Merrell, and, R. Vlietstra. 1985. Antibiotic treatment and relapse in Whipple’s disease: long term follow-up of 88 patients. Gastroenterology. 88:18671873.
63. Lee, A. G. 2002. Whipple disease with supranuclear ophthalmoplegia diagnosed by polymerase chain reaction of cerebrospinal fluid. J. Neuroophthalmol. 22:1821.
64. Leidig, P.,, M. Stolte,, B. Krakamp, and, S. Störkel. 1994. Whipple‘s disease—a rare cause of secondary amyloidosis. Z. Gastroenterol. 2:109112.
65. Lepidi, H.,, B. Coulibaly,, J. P. Casalta, and, D. Raoult. 2006. Autoimmunohistochemistry: a new method for the histologic diagnosis of infective endocarditis. J. Infect. Dis. 193:17111717.
66. Lepidi, H.,, F. Fenollar,, R. Gerolami,, J. L. Mege,, M. F. Bonzi,, M. Chappuis,, J. Sahel, and, D. Raoult. 2003. Whipple’s disease: immunospecific and quantitative immunohistochemical study of intestinal biopsy specimens. Hum. Pathol. 34:589596.
67. LeVine, M. E.,, and W. O. Dobbins III. 1973. Joint changes in Whipple’s disease. Semin. Arthritis Rheum. 3:7993.
68. Li, W.,, F. Fenollar,, J. M. Rolain,, P. E. Fournier,, G. E. Feurle,, C. Müller,, V. Moos,, T. Marth,, M. Altwegg,, R. C. Calligaris-Maibach,, T. Schneider,, F. Biagi,, B. La Scola, and, D. Raoult. 2008. Genotyping reveals a wide heterogeneity of Tropheryma whipplei. Microbiology 154:521527.
69. Lohr, M.,, W. Stenzel,, G. Plum,, W. P. Gross,, M. Deckert, and, N. Klug. 2004. Whipple’s disease confined to the central nervous system presenting as a solitary frontal tumor: case report. J. Neurosurg. 101:336339.
70. Louis, E. D.,, T. Lynch,, P. Kaufmann,, S. Fahn, and, J. Odel. 1996. Diagnostic guidelines in central nervous system Whipple’s disease. Ann. Neurol. 40:561568.
71. Reference deleted.
72. Lynch, T.,, J. Odel, and, D. N. Fredericks. 1997. Polymerase chain reaction-based detection of Tropheryma whippelii in central nervous system Whipple’s disease. Ann. Neurol. 42:120124.
73. Mahnel, R.,, A. Kalt,, S. Ring,, A. Stallmach,, W. Strober, and, T. Marth. 2005. Immunosuppressive therapy in Whipple’s disease patients is associated with the appearance of gastrointestinal manifestations. Am. J. Gastroenterol. 100:11671173.
74. Maiwald, M.,, H. J. Ditton,, A. von Herbay,, F. A. Rainey, and, E. Stackerbrandt. 1996. Reassessment of the phylogenetic position of the bacterium associated with Whipple’s disease and determination of the 16S–23S ribosomal intergenic spacer sequence. Int. J. Syst. Bacteriol. 46:10781082.
75. Maiwald, M.,, H. J. Ditton,, A. von Herbay,, F. A. Rainey, and, E. Stackerbrandt. 1999. Environmental occurrence of the Whipple’s disease bacterium (Tropheryma whippelii). Appl. Environ. Microbiol. 64:760762.
76. Maiwald, M.,, A. von Herbay,, D. H. Persing,, P. P. Mitchell,, M. F. Abdelmalek,, J. N. Thorvilson,, D. N. Fredricks, and, D. A. Relman. 2001. Tropheryma whippelii DNA is rare in the intestinal mucosa of patients without other evidence of Whipple disease. Ann. Intern. Med. 2:115119.
77. Maizel, H.,, J. M. Ruffin, and, W. O. Dobbins III. 1970. Whipple’s disease: a review of 19 patients from one hospital and a review of the literature since 1950. Medicine (Baltimore) 72:343355.
78. Marth, T. 2005. Whipple’s disease. p. 1306–1310. In G. Mandell,, J. Dolin, and, R. Bennett (ed.), Principles and Practice of Infectious Disease, 6th ed. Churchill Livingstone, Philadelphia, PA.
79. Marth, T.,, N. Kleen,, A. Stallmach,, S. Ring,, S. Aziz,, C. Schmidt,, W. Strober,, M. Zeitz, and, T. Schneider. 2002. Dys-regulated peripheral and mucosal Th1/Th2 response in Whipple‘s disease. Gastroenterology 123:14681477.
80. Marth, T.,, M. Neurath,, B. A. Cuccherini, and, W. Strober. 1997. Defects of monocyte interleukin-12 production and humoral immunity in Whipple’s disease. Gastroenterology 113:442448.
81. Marth, T.,, and D. Raoult. 2003. Whipple’s disease. Lancet 361:239246.
82. Marth, T.,, M. Roux,, A. von Herbay,, S. C. Meuer, and, G. E. Feurle. 1994. Persistent reduction of complement receptor 3 alpha-chain expressing mononuclear blood cells and transient inhibitory serum factors in Whipple’s disease. Clin. Immunol. Immunopathol. 72:217226.
83. Marth, T.,, and W. Strober. 1996. Whipple’s disease. Semin. Gastrointest. Dis. 7:4148.
84. Martinetti, M.,, F. Biagi,, C. Badulli,, G. E. Feurle,, C. Muller,, V. Moos,, T. Schneider,, T. Marth,, A. Marchese,, L. Trotta,, S. Sachetto,, A. Pasi,, A. De Silvestri,, L. Salvaneschi, and, G. R. Corazza. 2009. The HLA alleles DRB1*13 and DQB1*06 are associated to Whipple’s disease. Gastroenterology, 26 January 2009 [Epub ahead of print].
85. Maxwell, J. D.,, A. Ferguson,, A. M. McCay,, R. C. Imrie, and, W. C. Watson. 1968. Lymphocytes in Whipple’s disease. Lancet i:887889.
86. Meier-Willersen, H. J.,, M. Maiwald, and, A. von Herbay. 1993. Whipple‘s disease associated with opportunistic infections. Dtsch. Med. Wochenschr. 23:854860.
87. Messori, A.,, P. Di Bella, and, G. Polonara. 2001. An unusual spinal presentation of Whipple disease. Am. J. Neuroradiol. 22:10041008.
88. Misbah, S. A.,, B. Ozols,, A. Franks, and, N. Mapstone. 1997. Whipple’s disease without malabsorption: new atypical features. QJM 90:765772.
89. Moos, V.,, D. Kunkel,, T. Marth,, G. E. Feurle,, B. LaScola,, R. Ignatius,, M. Zeitz, and, T. Schneider. 2006. Reduced peripheral and mucosal T. whipplei-specific Th1 response in patients with Whipple’s disease. J. Immunol. 177:20152022.
90. Naegeli, B.,, F. Bannwart, and, O. Bertel. 2000. An uncommon cause of recurrent strokes. Tropheryma whippelii endocarditis. Stroke 31:20022003.
91. Papadopoulou, M.,, M. Rentzos,, C. Nicolaou,, V. Ioannidou,, A. Ioannidis, and, S. Chatzipanagiotou. 2003. Cerebral Whipple’s disease diagnosed using PCR: the first case reported from Greece. Mol. Diagn. 7:209211.
92. Paulley, D. 1952. A case of Whipple’s disease. Gastroenterology 22:128133.
93. Peters, G.,, D. G. du Plessis, and, P. R. Humphrey. 2002. Cerebral Whipple’s disease with a stroke-like presentation and cerebrovascular pathology. J. Neurol. Neurosurg. Psychiatry 73:336339.
94. Posada, I. J.,, A. Ferreiro-Sieiro,, E. Lopez-Valdes,, A. Cabello, and, F. Bermejo-Pareja. 2004. Whipple’s disease confined to the brain: a clinical case with pathological confirmation at necropsy. Rev. Neurol. 38:196198.
95. Raoult, D.,, M. L. Birg,, B. La Scola,, P. E. Fournier,, M. Enea,, H. Lepidi,, V. Roux,, J. C. Piette,, F. Vandenesch,, D. Vital Durand, and, T. J. Marrie. 2000. Cultivation of the bacillus of Whipple’s disease. N. Engl. J. Med. 342:620625.
96. Raoult D.,, H. Ogata,, S. Audic,, C. Robert,, K. Suhre, and, M. Drancourt. 2003. Tropheryma whipplei twist: a human pathogenic Actinobacteria with a reduced genome. Genome Res. 13:18001809.
97. Relman, D. A.,, T. M. Schmidt,, R. P. Mac Dermot, and, S. Falkow. 1992. Identification of the uncultured bacillus of Whipple’s disease. N. Eng. J. Med. 30:293301.
98. Renesto. P.,, N. Crapoulet,, H. Ogata,, B. La Scola,, G. Vestris,, J. M. Claverie, and, D. Raoult. 2003. Genome-based design of a cell-free culture medium for Tropheryma whipplei. Lancet 362:447449.
99. Rodarte, J. R.,, C. O. Garrison,, K. E. Holley, and, R. S. Fontana. 1972. Whipple’s disease simulating sarcoidosis. Arch. Intern. Med. 129:479482.
100. Rouillon, A.,, C. J. Menkes,, J. C. Gerster,, I. Perez-Sawka, and, M. Forest. 1993. Sarcoid-like forms of Whipple’s disease. Report of 2 cases. J. Rheumatol. 20:10701072.
101. Scheib, J. S.,, and R. J. Quinet. 1990. Whipple’s disease with axial and peripheral joint destruction. South. Med. J. 83:684687.
102. Schneider, T.,, V. Moos,, C. Loddenkemper,, T. Marth,, F. Fenollar, and, D. Raoult. 2008. Whipple’s disease: new aspects of pathogenesis and treatment. Lancet Infect. Dis. 8:179190.
103. Schnider, P. J.,, E. C. Reisinger, and, W. Gerschlager. 1996. Long-term follow-up in cerebral Whipple’s disease. Eur. J. Gastroenterol. Hepatol. 8:899903.
104. Schoedon, G.,, D. Goldenberger,, R. Forrer,, A. Gunz,, F. Dutly,, M. Höchli,, M. Altwegg, and, A. Schaffner. 1997. Deactivation of macrophages with interleukin-4 is the key to the isolation of Tropheryma whippelii. J. Infect. Dis. 176:672677.
105. Schöniger-Hekele, M.,, D. Petermann,, B. Weber, and, C. Müller. 2007. T. whipplei in the environment: survey of sewage plant influxes and sewage plant workers. Appl. Environ. Microbiol. 73:20332035.
106. Schröter, A.,, J. Brinkhoff, and, T. Günthner-Lengsfeld. 2005. Whipple’s disease presenting as an isolated lesion of the cervical spinal cord. Eur. J. Neurol. 12:276279.
107. Trier, J. S.,, P. C. Phelps,, S. Eidelmann, and, C. E. Rubin. 1965. Whipple’s disease: light and electron microscope correlation of jejunal mucosal histology with antibiotic treatment and clinical status. Gastroenterology 48:684707.
108. Upton, A. C. 1952. Histochemical investigation of the mesenchymal lesions in Whipple’s disease. Am. J. Clin. Pathol. 22:755764.
109. Von Herbay. A.,, H. J. Ditton,, F. Schuhmacher, and, M. Maiwald. 1997. Whipple‘s disease: staging and monitoring by cytology and polymerase chain reaction analysis of cerebrospinal fluid. Gastroenterology 113:434441.
110. Wang, S.,, L. M. Ernst,, B. R. Smith,, G. Tallini,, J. G. Howe,, J. Crouch, and, D. L. Cooper. 2003. Systemic Tropheryma whipplei infection associated with monoclonal B-cell proliferation: a Helicobacter pylori-type pathogenesis? Arch. Pathol. Lab. Med. 12:16191622.
111. Watanakunakorn, C.,, and Burkert T. 1993. Infective endocarditis at a large community teaching hospital, 1980–1990: a review of 210 episodes. Medicine (Baltimore) 72:90102.
112. Wilson, K. H.,, R. Blitchington,, R. Frothingam, and, J. A. Wilson. 1991. Phylogeny of the Whipple’s-disease-associated bacterium. Lancet 338:474475.
113. Yardley, J. H.,, and T. R. Hendrix. 1961. Combined electron and light microscopy in Whipple’s disease—demonstration of “bacillary bodies” in the intestine. Bull. Johns Hopkins Hosp. 109:8098.

Tables

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Table 1.

Percentage of individuals with Whipple’s disease showing specific clinical features

Citation: Marth T, Deriban G. 2009. Whipple’s Disease, p 205-216. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch11
Generic image for table
Table 2.

Long-term consequences of infection with

Citation: Marth T, Deriban G. 2009. Whipple’s Disease, p 205-216. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch11

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