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Whipple's disease and Tropheryma whipplei infections

when to suspect them and how to diagnose and treat them

Lagier, Jean-Christophe; Raoult, Didier

Current Opinion in Infectious Diseases: December 2018 - Volume 31 - Issue 6 - p 463–470
doi: 10.1097/QCO.0000000000000489
ANTIMICROBIAL AGENTS: BACTERIAL/FUNGAL: Edited by Monica A. Slavin

Purpose of review The delay between first clinical signs and diagnosis of Whipple's disease and Tropheryma whipplei infections is more than 6 years, and relapses are frequently observed, resulting in a need for clinicians to be aware of this infection.

Recent findings 18 FDG-PET is useful in the diagnosis and the follow-up of patients (particularly in case of neurological involvement). Histological involvement remains the goldstandard for classic Whipple's disease diagnosis. PCR performed on biopsies of fluid is the main tool for the diagnosis of localized chronic infections. PCR performed on urine samples should become an important role of noninvasive diagnostic strategies, while T. whipplei PCR performed on saliva and stool lack specificity. Because of lifetime susceptibility to T. whipplei and in-vitro susceptibility data, a 1-year course of doxycycline and hydroxychloroquine followed by a lifelong treatment by doxycycline is recommended for Whipple's disease, localized endocarditis and encephalitis.

Summary Clinical involvement of the different T. whipplei infections is well described, as well as the treatment of Whipple's disease, endocarditis and encephalitis. The place of PCR performed on urine remains to be clarified for diagnosis of localized T. whipplei infections and acute infections as well as the optimal treatment for arthritis and acute infections.

Aix Marseille Univ, IRD, MEPHI, IHU-Méditerranée Infection, Marseille, France

Correspondence to Professor Didier Raoult, Aix Marseille Université, IRD, MEPHI, IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005 Marseille, France. Tel: +33 4 13 73 24 01; fax: +33 4 13 73 24 02; e-mail: didier.raoult@gmail.com

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