Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 19, Number 11—November 2013

Tropheryma whipplei Endocarditis

Florence Fenollar, Marie Célard, Jean-Christophe Lagier, Hubert Lepidi, Pierre-Edouard Fournier, and Didier RaoultComments to Author 
Author affiliations: Aix-Marseille Université, Marseille, France (F. Fenollar, J.-C. Lagier, H. Lepidi, P.-E. Fournier, D. Raoult); Assistance Publique Hopitaux de Marseille, Marseille (F. Fenollar, J.-C. Lagier, P.-E. Fournier, D. Raoult); Groupement Hospitalier Est, Bron, France (M. Célard)

Main Article

Figure 1

Number of reported cases of Tropheryma whipplei endocarditis per 1 million inhabitants in each area of France over 10 years. Data from this series and the literature (22–24) were included. Among the metropolitan areas in France, the incidence of T. whipplei endocarditis is significantly more frequent in the Rhône-Alpes area than in 11 others areas (Alsace, Aquitaine, Basse-Normandie, Bourgogne, Centre, Champagne-Ardenne, Haute-Normandie, Ile de France, Languedoc-Roussillon, Midi-Pyrénées, and No

Figure 1. . . . . . Number of reported cases of Tropheryma whipplei endocarditis per 1 million inhabitants in each area of France over 10 years. Data from this series and the literature (2224) were included. Among the metropolitan areas in France, the incidence of T. whipplei endocarditis is significantly more frequent in the Rhône-Alpes area than in 11 others areas (Alsace, Aquitaine, Basse-Normandie, Bourgogne, Centre, Champagne-Ardenne, Haute-Normandie, Ile de France, Languedoc-Roussillon, Midi-Pyrénées, and Nord Pas-de-Calais; p = 0.04, p = 0.004, p = 0.048, p = 0.04, p = 0.01, p = 0.04, p = 0.02, p<0.001, p = 0.04, p = 0.007, p = 0.006, respectively). The incidence rate is also significantly more frequent in the Pays de la Loire area than in 6 other areas (Aquitaine, Bretagne, Centre, Ile-de France, Lorraine, Midi-Pyrénées, Nord Pas de Calais; p = 0.04, p = 0.04, p = 0.04, p = 0.003, p = 0.03, p = 0.02, respectively).

Main Article

  1. Moos  V, Schneider  T. Changing paradigms in Whipple’s disease and infection with Tropheryma whipplei. Eur J Clin Microbiol Infect Dis. 2011;30:11518. DOIPubMedGoogle Scholar
  2. Lagier  JC, Lepidi  H, Raoult  D, Fenollar  F. Systemic Tropheryma whipplei: clinical presentation of 142 patients with infections diagnosed or confirmed in a reference center. Medicine (Baltimore). 2010;89:33745. DOIPubMedGoogle Scholar
  3. Goldenberger  D, Kunzli  A, Vogt  P, Zbinden  R, Altwegg  M. Molecular diagnosis of bacterial endocarditis by broad-range PCR amplification and direct sequencing. J Clin Microbiol. 1997;35:27339 .PubMedGoogle Scholar
  4. Gubler  JG, Kuster  M, Dutly  F, Bannwart  F, Krause  M, Vögelin  HP, Whipple endocarditis without overt gastrointestinal disease: report of four cases. Ann Intern Med. 1999;131:1126. DOIPubMedGoogle Scholar
  5. Raoult  D, Birg  M, La Scola  B, Fournier  P, Enea  M, Lepidi  H, Cultivation of the bacillus of Whipple's disease. N Engl J Med. 2000;342:6205. DOIPubMedGoogle Scholar
  6. Fournier  PE, Thuny  F, Richet  H, Lepidi  H, Casalta  JP, Arzouni  JP, Comprehensive diagnostic strategy for blood culture–negative endocarditis: a prospective study of 819 new cases. Clin Infect Dis. 2010;51:13140. DOIPubMedGoogle Scholar
  7. Geissdörfer  W, Moos  V, Moter  A, Loddenkemper  C, Jansen  A, Tandler  R, High frequency of Tropheryma whipplei in culture-negative endocarditis. J Clin Microbiol. 2012;50:21622. DOIPubMedGoogle Scholar
  8. Voldstedlund  M, Norum  PL, Baandrup  U, Klaaborg  KE, Fuursted  K. Broad-range PCR and sequencing in routine diagnosis of infective endocarditis. APMIS. 2008;116:1908. DOIPubMedGoogle Scholar
  9. Bosshard  PP, Kronenberg  A, Zbinden  R, Ruef  C, Bottger  EC, Altwegg  M. Etiologic diagnosis of infective endocarditis by broad-range polymerase chain reaction: a 3-year experience. Clin Infect Dis. 2003;37:16772. DOIPubMedGoogle Scholar
  10. Grijalva  M, Horvath  R, Dendis  M, Erny  J, Benedik  J. Molecular diagnosis of culture negative infective endocarditis: clinical validation in a group of surgically treated patients. Heart. 2003;89:2638. DOIPubMedGoogle Scholar
  11. Marín  M, Muñoz  P, Sánchez  M, del Rosal  M, Alcalá  L, Rodríguez-Créixems  M, Molecular diagnosis of infective endocarditis by real-time broad-range polymerase chain reaction (PCR) and sequencing directly from heart valve tissue. Medicine (Baltimore). 2007;86:195202. DOIPubMedGoogle Scholar
  12. Benslimani  A, Fenollar  F, Lepidi  H, Raoult  D. Bacterial zoonoses and infective endocarditis, Algeria. Emerg Infect Dis. 2005;11:21624. DOIPubMedGoogle Scholar
  13. Fenollar  F, Laouira  S, Lepidi  H, Rolain  J, Raoult  D. Value of Tropheryma whipplei quantitative PCR assay for the diagnosis of Whipple’s disease: usefulness of saliva and stool specimens for first-line screening. Clin Infect Dis. 2008;47:65967. DOIPubMedGoogle Scholar
  14. Li  W, Fenollar  F, Rolain  JM, Fournier  PE, Feurle  GE, Müller  C, Genotyping reveals a wide heterogeneity of Tropheryma whipplei. Microbiology. 2008;154:5217. DOIPubMedGoogle Scholar
  15. Lepidi  H, Fenollar  F, Dumler  JS, Gauduchon  V, Chalabreysse  L, Bammert  A, Cardiac valves in patients with Whipple endocarditis: microbiological, molecular, quantitative histologic, and immunohistochemical studies of 5 patients. J Infect Dis. 2004;190:93545. DOIPubMedGoogle Scholar
  16. Raoult  D, Fenollar  F, Birg  ML. Culture of Tropheryma whipplei from the stool of a patient with Whipple’s disease. N Engl J Med. 2006;355:15035. DOIPubMedGoogle Scholar
  17. Fenollar  F, Amphoux  B, Raoult  D. A paradoxical Tropheryma whipplei Western blot differentiates patients with Whipple’s disease from asymptomatic carriers. Clin Infect Dis. 2009;49:71723. DOIPubMedGoogle Scholar
  18. Ansemant  T, Celard  M, Tavernier  C, Maillefert  JF, Delahaye  F, Ornetti  P. Whipple’s disease endocarditis following anti-TNF therapy for atypical rheumatoid arthritis. Joint Bone Spine. 2010;77:6223. DOIPubMedGoogle Scholar
  19. Daïen  CI, Cohen  JD, Makinson  A, Battistella  P, Bilak  EJ, Jorgensen  C, Whipple’s endocarditis as a complication of tumour necrosis factor-alpha antagonist treatment in a man with ankylosing spondylitis. Rheumatology (Oxford). 2010;49:16002. DOIPubMedGoogle Scholar
  20. Li  JS, Sexton  DJ, Mick  N, Nettles  R, Fowler  VG Jr, Ryan  T, Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:6338. DOIPubMedGoogle Scholar
  21. Thuny  F, Grisoli  D, Collart  F, Habib  G, Raoult  D. Management of infective endocarditis: challenges and perspectives. Lancet. 2012;379:96575. DOIPubMedGoogle Scholar
  22. Besnard  S, Cady  A, Flecher  E, Fily  F, Revest  M, Arvieux  C, Should we systematically perform central nervous system imaging in patients with Whipple’s endocarditis? Am J Med. 2010;123:962.e–4.
  23. Brondex  A, Jobic  Y. Infective endocarditis as the only manifestation of Whipple’s disease: an atypical presentation. Ann Cardiol Angeiol (Paris). 2012;61:613. DOIPubMedGoogle Scholar
  24. Saba  M, Rollot  F, Park  S, Grimaldi  D, Sicard  D, Abad  S, Whipple disease, initially diagnosed as sarcoidosis. Presse Med. 2005;34:15214. DOIPubMedGoogle Scholar
  25. Lagier  JC, Fenollar  F, Lepidi  H, Raoult  D. Evidence of lifetime susceptibility to Tropheryma whipplei in patients with Whipple’s disease. J Antimicrob Chemother. 2011;66:11889. DOIPubMedGoogle Scholar
  26. Célard  M, de Gevigney  G, Mosnier  S, Buttard  P, Benito  Y, Etienne  J, 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. 1999;29:13489. DOIPubMedGoogle Scholar
  27. Chan  V, Wang  B, Veinot  JP, Suh  KN, Rose  G, Desjardins  M, Tropheryma whipplei aortic valve endocarditis without systemic Whipple’s disease. Int J Infect Dis. 2011;15:e8046. DOIPubMedGoogle Scholar
  28. Dreier  J, Szabados  F, von Herbay  A, Kroger  T, Kleesiek  K. Tropheryma whipplei infection of an acellular porcine heart valve bioprosthesis in a patient who did not have intestinal Whipple’s disease. J Clin Microbiol. 2004;42:448793. DOIPubMedGoogle Scholar
  29. Escher  R, Roth  S, Droz  S, Egli  K, Altwegg  M, Tauber  MG. Endocarditis due to Tropheryma whipplei: rapid detection, limited genetic diversity, and long-term clinical outcome in a local experience. Clin Microbiol Infect. 2010;16:121322. DOIPubMedGoogle Scholar
  30. Gabus  V, Grenak-Degoumois  Z, Jeanneret  S, Rakotoarimanana  R, Greub  G, Genne  D. Tropheryma whipplei tricuspid endocarditis: a case report and review of the literature. J Med Case Reports. 2010;4:245. DOIPubMedGoogle Scholar
  31. Kolek  M, Zaloudikova  B, Freiberger  T, Brat  R. Aortic and mitral valve infective endocarditis caused by Tropheryma whipplei and with no gastrointestinal manifestations of Whipple’s disease. Klin Mikrobiol Infekc Lek. 2007;13:2136 .PubMedGoogle Scholar
  32. Mallmann  C, Siemoneit  S, Schmiedel  D, Petrich  A, Gescher  DM, Halle  E, Fluorescence in situ hybridization to improve the diagnosis of endocarditis: a pilot study. Clin Microbiol Infect. 2010;16:76773. DOIPubMedGoogle Scholar
  33. Miguelena  J, Munoz  R, Maseda  R, Epeldegui  A. Endocarditis due to Tropheryma whipplei. Rev Esp Cardiol. 2010;63:2501. DOIPubMedGoogle Scholar
  34. Naegeli  B, Bannwart  F, Bertel  O. An uncommon cause of recurrent strokes: Tropheryma whippelii endocarditis. Stroke. 2000;31:20023 . DOIPubMedGoogle Scholar
  35. Voldstedlund  M, Pedersen  LN, Baandrup  U, Fuursted  K. Whipple’s disease—a cause of culture-negative endocarditis. Ugeskr Laeger. 2004;166:37312 .PubMedGoogle Scholar
  36. West  D, Hutcheon  S, Kain  R, Reid  T, Walton  S, Buchan  K. Whipple’s endocarditis. J R Soc Med. 2005;98:3624 . DOIPubMedGoogle Scholar
  37. Whistance  RN, Elfarouki  GW, Vohra  HA, Livesey  SA. A case of Tropheryma whipplei infective endocarditis of the aortic and mitral valves in association with psoriatic arthritis and lumbar discitis. J Heart Valve Dis. 2011;20:3536 .PubMedGoogle Scholar
  38. Williams  OM, Nightingale  AK, Hartley  J. Whipple’s disease. N Engl J Med. 2007;356:147981. DOIPubMedGoogle Scholar
  39. Love  SM, Morrison  L, Appleby  C, Modi  P. Tropheryma whipplei endocarditis without gastrointestinal involvement. Interact Cardiovasc Thorac Surg. 2012;15:1613. DOIPubMedGoogle Scholar
  40. Greub  G, Lepidi  H, Rovery  C, Casalta  JP, Raoult  D. Diagnosis of infectious endocarditis in patients undergoing valve surgery. Am J Med. 2005;118:2308. DOIPubMedGoogle Scholar

Main Article

Page created: October 28, 2013
Page updated: October 28, 2013
Page reviewed: October 28, 2013
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.