Valvular Endocarditis and Biventricular Heart Failure in the Setting of Tropheryma whipplei Disease.

Whipple disease is a rare systemic illness associated with weight loss, diarrhea, and arthralgia. Asymptomatic carriage is common, but the disease can be complicated by cardiac involvement and may result in culture-negative endocarditis. Cardiac manifestations of the disease can lead to death. This report presents the case of a 66-year-old man with Whipple disease and biventricular heart failure with cardiogenic shock. Medical therapy followed by successful replacement of the aortic and mitral valves resulted in substantial improvement.

Tropheryma whipplei pneumonia revealed by Metagenomic next-generation sequencing: Report of two cases.

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.

Tropheryma whipplei detected by metagenomic next-generation sequencing in bronchoalveolar lavage fluid.

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.

Whipple disease after bariatric surgery: from malabsorption to malnutrition status / La enfermedad de Whipple después de cirugía bariátrica: de la malabsorción a la malnutrición

Malabsorptive bariatric techniques are associated with nutritional deficiencies. However, when patients do not respond to supplemental intensive treatments they should be closely followed because they can hide other pathological conditions. We present the case of a 47-year-old man with morbid obesity (body mass index [BMI]: 48 kg/m2) who underwent bariatric surgery. In 2016, he presented severe pneumonia and hospitalization at the Intensive Unit Care was required. After this episode, his nutritional state impaired, presenting 6-7 diarrhea/steatorrhea events per-day and requiring several hospitalizations due to the persistence of severe hypoproteinemia. He was given parenteral high-protein associated with low-fat oral diet. He presented a temporary biochemical improvement, but the hypoproteinemia recurred. Finally, tests revealed the presence of Tropheryma whipplei as protein-losing enteropathy. Whipple's disease (WD) is a rare cause of diarrhea and malnutrition, and these symptoms can be confused with the postoperative status of malabsorptive bariatric techniques. WD requires early diagnosis with prolonged antibiotic treatment to avoid severe complications

Las técnicas bariátricas malabsortivas suelen asociarse a deficiencias nutricionales. Sin embargo, cuando los pacientes no responden a tratamientos intensivos suplementarios, deben valorarse otras condiciones patológicas. Presentamos el caso de un hombre de 47 años, obeso mórbido (índice de masa corporal [IMC]: 48 kg/m2) sometido a cirugía bariátrica, que dos años más tarde presentó neumonía severa, por lo que requirió ingreso en la Unidad de Cuidados Intensivos. Posteriormente, el estado nutricional se deterioró, presentando 6-7 episodios de diarrea-esteatorrea/día y requiriendo varias hospitalizaciones por hipoproteinemia severa. Recibió infusión parenteral rica en proteínas asociada con una dieta baja en grasas y presentó mejoría analítica temporal. Finalmente, las pruebas revelaron la presencia de Tropheryma whipplei, una bacteria que genera enteropatía pierde-proteínas. La enfermedad de Whipple (EW) es una causa poco común de diarrea y malnutrición. Estos síntomas pueden confundirse con el posoperatorio de técnicas bariátricas malabsortivas. La EW requiere un diagnóstico precoz con un tratamiento antibiótico prolongado para evitar complicaciones graves

Enfermedad de Whipple: una infrecuente causa bacteriana de demencia / Whipple’s Disease: an uncommon cause of dementia

Presentamos un caso de demencia diagnosticada como Alzheimer, cuya evolución condujo al diagnóstico final de una enfermedad de Whipple cerebral (AU)

We present a dementia case, diagnosed as Alzheimer type. Nevertheless, the final diagnosis of Whipple’s disease was delayed (AU)

Diagnóstico microbiológico de las infecciones por patógenos bacterianos emergentes: Anaplasma, Bartonella, Rickettsia, Tropheryma whipplei / Microbiological diagnosis of emerging bacterial pathogens: Anaplasma, Bartonella, Rickettsia, and Tropheryma whipplei

Ehrlichia/Anaplasma, Bartonella, Rickettsia y Tropherymawhipplei (antes llamado whippelii) constituyen un claro ejemplo de bacterias de difícil cultivo que causan enfermedades emergentes y reemergentes de potencial gravedad e importancia en salud pública. En los últimos años la disponibilidad de técnicas de biología molecular y de cultivo celular ha permitido que muchas de estas especies se hayan implicado en patología humana. El desarrollo de todos estos aspectos, con (..) (AU)

Ehrlichia/Anaplasma, Bartonella, Rickettsia and Tropherymawhipplei (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 (..) (AU)

Tratamiento en la enfermedad de Whipple. Caso clínico y revisión / No disponible

La enfermedad de Whipple (EW) es una rara enfermedad sistémica, de evolución crónica, causada por la bacteria Tropheryma whippelii (TW). Los síntomas son muy variados, tanto gastrointestinales como extraintestinales, según sea la localización de la bacteria. Debido a que comparte síntomas y características con otras enfermedades causadas también por bacterias, el diagnóstico precoz es muy complicado y necesita de numerosas pruebas. El método para su diagnóstico definitivo es el estudio histológico. La TW se describió por primera vez hace casi un siglo, pero sigue siendo una incógnita en nuestros días su mecanismo de transmisión, reservorio, tratamiento más efectivo, etc. Es muy importante iniciar el tratamiento lo antes posible, debido a que la enfermedad puede llegar a ser mortal, y éste debe prolongarse durante un año para evitar las recidivas, las cuales afectan al sistema nervioso central, de ahí lo importante de realizar un seguimiento farmacoterapéutico para asegurarse de que el paciente completa el tratamiento. Las bases del tratamiento han sido hasta ahora empíricas, utilizándose Estreptomicina más b-lactámico para comenzar y continuando con trimetoprin-sulfametoxazol como tratamiento domiciliario. Pero el conocimiento de sus características microbiológicas ha llevado a probar otros antibióticos y el logro de su cultivo in vitro a la realización de antibiogramas de sensibilidad. Describimos el caso clínico de un hombre de 61 años que presentaba síntomas gastrointestinales; el diagnóstico definitivo de EW se alcanzó con una biopsia iniciándose entonces el tratamiento con antibióticos con los que evolucionó adecuadamente. Ha seguido tratamiento domiciliario y se le ha realizado un seguimiento en consulta, donde se le detectó una neuropatía periférica, la cual remitió espontáneamente y el paciente continúa asintomático (AU)

The Whipple's disease is a rare systematic disease, of chronic evolution, caused by the bacterium Tropheryma whippelii (TW). The symptoms are very various; so much gastrointestinal as extraintestinal, as be the locating of the bacterium. Due to that shares symptoms and characteristics with other illnesses caused also by bacteriums, the premature diagnosis is very complicated and needs numerous tests. The method for its final diagnosis is the histological study. The TW was described for the first time almost a century ago, but continues being an unknown quantity in our days its mechanism of broadcast, reservoir, more effective processing, etc. It is very important to iniciate the processing as soon as possible, due to that the disease can come be mortal, and this should be prolonged during a year to avoid the relapses, which damage the central nervous system, from there what is important to carry out a pharmacotherapeutics monitoring to the patient to be assured that being utilized Streptomycin more b-lactamic to being and continuing with trimethoprim-sulfamethoxazole as home processing. But the knowledge of its microbiologicals characteristic has carried to test other antibiotics and the achievement of its cultivation in vitro to the execution of antibiograms of sensibility. We describe the clinic case of a man of 61 years that presented gastrointestinal symptoms, the final diagnosis of Whipple's disease was reached with a biopsy being initiated then the processing with antibiotics with the ones that evolved adequate. It has followed home processing and has been carried out a monitoring in outpatients department, where was detected a pheripheral neuropathy, which remitted spontaneously and the patient continues asymptomatic (AU)