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1.
Acta Gastroenterol Belg ; 84(4): 669-671, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34965051

RESUMO

Whipple's disease is a rare chronic systemic infection caused by Tropheryma whipplei. The widespread infection by this rod is responsible for the protean clinical manifestations of the disease, although its classical form is notable for the prevalence of abdominal symptoms such as chronic diarrhea and abdominal pain. Whitish-yellow patches, suggestive of lymphangiectasia, are typically observed in the duodenum during upper endoscopy. The diagnosis of this condition is supported by the identification in duodenal biopsies of Periodic acid-Schiff staining within lamina propria macrophages. Nevertheless, a significant portion of patients do not have lesions within the range of conventional upper endoscopy. Therefore, other endoscopic procedures such as video capsule endoscopy and enteroscopy may be useful to detect more distal lesions. The authors describe a case where the combined used of both techniques allowed the unmasking of this disease.


Assuntos
Doença de Whipple , Antibacterianos/uso terapêutico , Duodeno/diagnóstico por imagem , Endoscopia Gastrointestinal , Humanos , Tropheryma , Doença de Whipple/diagnóstico , Doença de Whipple/tratamento farmacológico
2.
Front Public Health ; 9: 729595, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34760862

RESUMO

Whipple's disease is a very rare systemic infectious disease, and very few cases have been reported. However, it can be fatal if not diagnosed and treated appropriately. The major clinical manifestations of this disease are usually digestive and nervous system symptoms. The majority of patients are male and between 40 and 50 years old. Although respiratory symptoms of this disease have rarely been reported, they pose a serious threat to the lives of the patients, especially when they progress to severe pneumonia. During admission to the hospital, Acinetobacter baumannii infection makes treatment more difficult. While most patients are middle-aged men, more attention should be given to the diagnosis and treatment of affected young women. To our knowledge, the case presented in the study is the first case of Tropheryma whipplei infection that resulted in severe pneumonia and was complicated by A. baumannii infection during treatment. We hope that our study can serve as a reference for the diagnosis and treatment of related cases in the future.


Assuntos
Infecções por Acinetobacter , Acinetobacter baumannii , Pneumonia , Doença de Whipple , Infecções por Acinetobacter/diagnóstico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tropheryma/genética , Doença de Whipple/complicações
3.
Front Public Health ; 9: 663093, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34485213

RESUMO

Introduction: Pneumocystis pneumonia (PCP) is one of the most common opportunistic infections in HIV-infected patients. However, coinfection with Tropheryma whipplei is infrequent in AIDS patients with PCP. Case Presentation: We report a 28-year-old male AIDS patient coinfected with T. whipplei and Pneumocystis jirovecii diagnosed in the bronchoalveolar lavage. After sulfamethoxazole-trimethoprim and meropenem treatment, the patient showed clinical improvement in 2 weeks. Conclusion: Clinicians need to be alert to the occurrence of T. whipplei infection in AIDS patients with PCP and timely diagnosis and antibacterial treatments are essential. This case may help clinicians for timely diagnosis of the coinfection of T. whipplei and P. jirovecii in AIDS patients.


Assuntos
Síndrome de Imunodeficiência Adquirida , Pneumocystis carinii , Pneumonia por Pneumocystis , Síndrome de Imunodeficiência Adquirida/complicações , Adulto , Humanos , Masculino , Pneumonia por Pneumocystis/complicações , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Tropheryma/genética
4.
J Med Case Rep ; 15(1): 359, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34243811

RESUMO

BACKGROUND: We diagnosed a clinical case of pulmonary infection involving Mycobacterium tuberculosis and Tropheryma whipplei in a patient with acute respiratory distress syndrome. The diagnosis was assisted by metagenomic next-generation sequencing of bronchoalveolar lavage fluid. CASE PRESENTATION: A 44-year-old Han Chinese inmate was transferred to the emergency department because of dry cough, chest tightness, and shortness of breath. The patient's body temperature rose to 39.3 °C following empirical cephalosporin treatment for 1 week. The blood CD4+/CD8+ ratio was 0.7, suggesting immunodeficiency. Routine microbiological tests were performed, and tuberculosis interferon gamma release assays were positive. Mycobacterium tuberculosis polymerase chain reaction was also positive. Chest computed tomography scan revealed miliary nodules and ground-glass opacifications, which were in accordance with tuberculosis. To fully examine the etiology, we performed routine laboratory tests and metagenomic sequencing, the results of which indicated the presence of Mycobacterium tuberculosis and Tropheryma whipplei. We administered anti-tuberculosis regimen in combination with trimethoprim/sulfamethoxazole. The patient recovered, with chest computed tomography scan showing absorption of lesions. CONCLUSIONS: Compared with traditional diagnostic methods such as culture and serology, metagenomic next-generation sequencing has the advantage of detecting a wide array of microorganisms in a single test and therefore can be used for clinical diagnosis of rare pathogens and microbial coinfections. It is particularly useful for immunocompromised patients as they are more prone to infection by opportunistic microorganisms.


Assuntos
Coinfecção , Mycobacterium tuberculosis , Adulto , Líquido da Lavagem Broncoalveolar , Coinfecção/diagnóstico , Humanos , Pulmão/diagnóstico por imagem , Mycobacterium tuberculosis/genética , Tropheryma
5.
Rev Med Interne ; 42(11): 801-804, 2021 Nov.
Artigo em Francês | MEDLINE | ID: mdl-34218934

RESUMO

INTRODUCTION: Whipple's disease (WD) can mimic chronic inflammatory rheumatism leading to incorrect prescription of tumor necrosis factor inhibitors (TNFI). Several complicated cases of WD have been reported during TNFI treatment which is strongly suspected to modify the host-pathogen relationship. Tropheryma whipplei asymptomatic carriage is high in the general population, making the diagnosis of WD more difficult face to unexplained arthritis. OBSERVATIONS: We report three observations that illustrate situations for which the detection of T. whipplei might be valuable to investigate the differential diagnosis of inflammatory rheumatism. CONCLUSION: The decision to check for T. whipplei infection should rely on individual clinical assessment. It should be considered in the absence of clinical response or in case of worsening of an inflammatory rheumatism under TNFI treatment, especially in front of atypical features. A systematic screening for T. whipplei before anti-TNF treatment seems unjustified since asymptomatic carriers are frequent.


Assuntos
Artrite Reumatoide , Febre Reumática , Doença de Whipple , Antibacterianos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Humanos , Febre Reumática/tratamento farmacológico , Tropheryma , Inibidores do Fator de Necrose Tumoral , Doença de Whipple/complicações , Doença de Whipple/diagnóstico , Doença de Whipple/tratamento farmacológico
6.
Microb Pathog ; 158: 105074, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34182076

RESUMO

Tropheryma whipplei is a bacterial pathogen responsible for a wide range of infections in humans, covering asymptomatic carriage, acute infections, chronic isolated infections and classic Whipple's disease. Although the bacterium is commonly found in the environment, it very rarely causes disease. Genetic comparison of clinical isolates has revealed that main variations were found in region encoding T. whipplei surface glycoproteins called WiSP. However, no association has been made between the genetic diversity and the clinical manifestations of the infection. In this study we evaluated the phenotypic diversity of 26 clinical isolates from different origins and taken from patient with different infection outcomes. MRC5 and macrophages cells were infected, and bacterial uptake, survival and the pro-and anti-inflammatory potential of the different clinical isolates was assessed. No significant difference of phagocytosis was found between the different isolates; however, we found that bacterial replication was increased for bacteria expressing high molecular weight WiSP. In addition, we found that the expression of the genes coding for IL-1ß and TGF-ß was significantly higher when MRC5 cells were stimulated with isolates from chronic infections compared to isolates from localized infections while no significant differences were observed in macrophages. Overall, our study revealed that, as previously observed at the genetic level, phenotypic diversity of T. whipplei isolates is associated with the expression of different WiSP, which may result in subtle differences in host responses. Other host factors or genetic predisposition may explain the range of clinical manifestations of T. whipplei infections.


Assuntos
Tropheryma , Doença de Whipple , Humanos , Tropheryma/genética
7.
Front Immunol ; 12: 667357, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34093562

RESUMO

Tropheryma whipplei is the agent of Whipple's disease, a rare systemic disease characterized by macrophage infiltration of the intestinal mucosa. The disease first manifests as arthralgia and/or arthropathy that usually precede the diagnosis by years, and which may push clinicians to prescribe Tumor necrosis factor inhibitors (TNFI) to treat unexplained arthralgia. However, such therapies have been associated with exacerbation of subclinical undiagnosed Whipple's disease. The objective of this study was to delineate the biological basis of disease exacerbation. We found that etanercept, adalimumab or certolizumab treatment of monocyte-derived macrophages from healthy subjects significantly increased bacterial replication in vitro without affecting uptake. Interestingly, this effect was associated with macrophage repolarization and increased rate of apoptosis. Further analysis revealed that in patients for whom Whipple's disease diagnosis was made while under TNFI therapy, apoptosis was increased in duodenal tissue specimens as compared with control Whipple's disease patients who never received TNFI prior diagnosis. In addition, IFN-γ expression was increased in duodenal biopsy specimen and circulating levels of IFN-γ were higher in patients for whom Whipple's disease diagnosis was made while under TNFI therapy. Taken together, our findings establish that TNFI aggravate/exacerbate latent or subclinical undiagnosed Whipple's disease by promoting a strong inflammatory response and apoptosis and confirm that patients may be screened for T. whipplei prior to introduction of TNFI therapy.


Assuntos
Macrófagos/metabolismo , Inibidores do Fator de Necrose Tumoral/uso terapêutico , Doença de Whipple/tratamento farmacológico , Doença de Whipple/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Apoptose , Feminino , Humanos , Mucosa Intestinal/metabolismo , Macrófagos/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Tropheryma/imunologia
8.
BMJ Case Rep ; 14(6)2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34144955

RESUMO

We present the case of a 70-year-old woman with a history of seronegative arthritis, recurrent pleural effusion and weight loss. A prior lung biopsy had revealed non-caseating epithelioid cell granulomas without evidence for microbial organisms on special stains. Intestinal biopsy findings where suspicious for Whipple's disease, which was confirmed by PCR testing, both on the intestinal and retrospectively on the lung tissue. Treatment with ceftriaxone resulted in clinical deterioration with fever, arthritis and recurrent pleuritis consistent with immune reconstitution inflammatory syndrome. Dose increase of glucocorticoids and therapy rotation to doxycycline and hydroxychloroquine resulted in rapid clinical improvement.


Assuntos
Síndrome Inflamatória da Reconstituição Imune , Pneumopatias , Doença de Whipple , Idoso , Antibacterianos/uso terapêutico , Feminino , Humanos , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Pneumopatias/tratamento farmacológico , Estudos Retrospectivos , Tropheryma , Doença de Whipple/complicações , Doença de Whipple/diagnóstico , Doença de Whipple/tratamento farmacológico
11.
R I Med J (2013) ; 104(4): 43-45, 2021 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-33926159

RESUMO

Whipple's disease is a rare infectious disease caused by the bacterium Tropheryma whipplei. The prevalence of Whipple's disease is 3/1,000,000 in Western populations. It most often causes a malabsorption disorder with weight loss and diarrhea as common presenting symptoms. In one-third of patients, however, there are no gastrointestinal symptoms at presentation; patients instead report a wide variety of non-specific extraintestinal complaints, potentially involving every organ system. We report a case of a 37-year-old man who presented with a 3-month history of non-bloody diarrhea and 15-pound weight loss. He was ultimately diagnosed with biopsy-confirmed Whipple's disease. Despite its rarity, Whipple's disease remains an important clinical entity and should be included on the differential diagnosis for selected patients presenting with an array of non-specific symptoms.


Assuntos
Doença de Whipple , Adulto , Antibacterianos/uso terapêutico , Biópsia , Diarreia/diagnóstico , Humanos , Masculino , Tropheryma , Doença de Whipple/diagnóstico , Doença de Whipple/tratamento farmacológico
12.
Echocardiography ; 38(4): 697-700, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33711181

RESUMO

Tropheryma whipplei is a bacterium that causes a rare infection called Whipple's disease and can cause devastating effects if left untreated. It is important to recognize that patients with this infection may present with atypical symptoms and are often apyrexial with normal inflammatory markers. Moreover, routine blood cultures often do not isolate these bacteria in conventional growth media. Therefore, it requires a high level of clinical suspicion to make this diagnosis. Here, we present two cases of Tropheryma whipplei aortic valve endocarditis, with atypical presentation and similar unusual but striking echocardiographic images.


Assuntos
Endocardite Bacteriana , Endocardite , Doença de Whipple , Ecocardiografia , Endocardite Bacteriana/diagnóstico por imagem , Humanos , Tropheryma , Doença de Whipple/complicações , Doença de Whipple/diagnóstico
13.
BMC Gastroenterol ; 21(1): 128, 2021 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-33743602

RESUMO

BACKGROUND: Whipple's disease is a chronic infectious disease that primarily affects the small intestine, but several organs can simultaneously be involved. The disease is caused by a gram-positive bacterium called Tropheryma whipplei. The disease is difficult to suspect because it is rare with unspecific and long-term symptoms; it can be lethal if not properly treated. CASE PRESENTATION: We here present three patients who presented with a plethora of symptoms, mainly long-standing seronegative arthritis and gastrointestinal symptoms in the form of diarrhea with blood, weight loss, fever, and lymphadenopathy. They were after extensive investigations diagnosed with Whipple's disease, in two of them as long as 8 years after the first occurrence of joint manifestations. The diagnosis was made by PCR targeting the T. whipplei 16S rRNA gene from small bowel specimen in all three patients, and, besides from histopathologic findings from the duodenum and distal ileum in one and mesenteric lymph nodes in another patient. CONCLUSIONS: This report aims to raise awareness of a very rare disease that presents with a combination of symptoms mimicking other and significantly more common diseases.


Assuntos
Doença de Whipple , Antibacterianos/uso terapêutico , Duodeno , Humanos , RNA Ribossômico 16S , Tropheryma/genética , Doença de Whipple/diagnóstico , Doença de Whipple/tratamento farmacológico
14.
Medicina (B.Aires) ; 81(1): 91-95, mar. 2021. graf
Artigo em Espanhol | LILACS | ID: biblio-1287245

RESUMO

Resumen La enfermedad de Whipple es una enfermedad multisistémica crónica, causada por la bacteria Tropherima whipplei. Se han descripto aproximadamente 1200 casos en la literatura. La incidencia mundial se estima en 9.8 casos por millón de personas. Los datos provenientes de Sudamérica y Europa muestran que afecta a varones de mediana edad. Se cree que los factores inmunológicos del huésped son los que influyen en el curso de la infección y no el genotipo del agente. Dado que las características clínicas no suelen ser específicas y el espectro de manifestaciones en órganos individuales puede ser subestimado, el diagnóstico sigue siendo muy difícil. Presentamos un caso confirmado por histopatología con compromiso multisistémico. Consideramos importante su difusión dados los escasos casos documentados en Sudamérica y la relevancia de tener presente la sospecha diagnóstica para el abordaje terapéutico precoz que mejora el pronóstico de esta rara enfermedad.


Abstract Whipple's disease is a chronic mutisystem disease caused by the bacteria Tropherima whipplei. Approximately 1200 cases have been described in the literature. The worldwide incidence is estimated at 9.8 cases per million people. Data from South America and Europe show that it affects middle-aged males. It is believed that host immunological factors rather than agent genotypic traits influence the course of the infection. Since the clinical characteristics are usually nonspecific and the wide spectrum of manifestations in individual organs may be underestimated, the diagnosis remains challenging. We present a case with multisystem compromise confirmed by histopathology. We consider its publication important given the few cases documented in South America and the relevance of bearing in mind the importance of an early diagnosis for a prompt treatment that improves the prognosis of this rare disease.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/etiologia , Doença de Whipple/complicações , Doença de Whipple/diagnóstico , Doença de Whipple/tratamento farmacológico , Europa (Continente) , Tropheryma , Antibacterianos/uso terapêutico
15.
Medicina (B Aires) ; 81(1): 91-95, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-33611249

RESUMO

Whipple's disease is a chronic mutisystem disease caused by the bacteria Tropherima whipplei. Approximately 1200 cases have been described in the literature. The worldwide incidence is estimated at 9.8 cases per million people. Data from South America and Europe show that it affects middle-aged males. It is believed that host immunological factors rather than agent genotypic traits influence the course of the infection. Since the clinical characteristics are usually nonspecific and the wide spectrum of manifestations in individual organs may be underestimated, the diagnosis remains challenging. We present a case with multisystem compromise confirmed by histopathology. We consider its publication important given the few cases documented in South America and the relevance of bearing in mind the importance of an early diagnosis for a prompt treatment that improves the prognosis of this rare disease.


Assuntos
Hipertensão Pulmonar , Doença de Whipple , Idoso , Antibacterianos/uso terapêutico , Europa (Continente) , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Tropheryma , Doença de Whipple/complicações , Doença de Whipple/diagnóstico , Doença de Whipple/tratamento farmacológico
16.
Emerg Infect Dis ; 27(3): 932-935, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33622479

RESUMO

We examined fecal specimens of patients with diarrhea from 3 continents for Tropheryma whipplei and enteropathogens. T. whipplei was most common in South Africa, followed by Singapore and Germany. Its presence was associated with the presence of other pathogens. An independent causative role in diarrhea appears unlikely.


Assuntos
Tropheryma , Doença de Whipple , Diarreia , Fezes , Alemanha , Humanos , Singapura , África do Sul
17.
BMC Pulm Med ; 21(1): 29, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33451316

RESUMO

BACKGROUND: Whipple's disease is a chronic infectious disease caused by the Gram-positive bacterium Tropheryma whipplei (TW), which not only affects the gastrointestinal tract and causes malabsorption of nutrients, but several other systems, such as the cardiovascular system, central nervous system, the joints, and the vascular system, can also be simultaneously involved. The aim of this report was to be able to alert the clinician to severe pneumonia caused by TW combined with Candida sp. CASE PRESENTATION: The case study was conducted on patients in September and November 2019. After routine examination and treatment, the results were not satisfactory. A bronchoalveolar lavage (BAL) using metagenomics next-generation sequencing was conducted on two adults who presented with fever, cough, and progressive dyspnea and who had no history of gastrointestinal symptoms, immunodeficiency diseases, or use of immunosuppressive agents. TW and Candida sp. were detected in in BAL. CONCLUSIONS: This is a report of life-threatening pneumonia caused by TW combined with Candida sp. in a Chinese population.


Assuntos
Líquido da Lavagem Broncoalveolar/microbiologia , Candida/genética , Candidíase/diagnóstico , Pneumonia/microbiologia , Tropheryma/genética , Doença de Whipple/diagnóstico , Adulto , Idoso de 80 Anos ou mais , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Tomografia Computadorizada por Raios X
20.
Internist (Berl) ; 62(4): 433-440, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33296012

RESUMO

Whipple disease is an infection caused by the bacterium Tropheryma whipplei. Due to its unspecific clinical symptoms, it is difficult to diagnose and often remains undetected for a long time. The case of a patient who presented with acute intestinal symptoms to the authors' department is reported. The diagnosis of classic Whipple disease was established. The symptoms subsided under antibiotic therapy. Complications in the form of immune reconstitution inflammatory syndrome (IRIS) occurred, requiring immunosuppressive treatment.


Assuntos
Síndrome Inflamatória da Reconstituição Imune , Doença de Whipple , Idoso , Antibacterianos/uso terapêutico , Artralgia/diagnóstico , Artralgia/tratamento farmacológico , Artralgia/etiologia , Humanos , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Imunossupressores , Masculino , Tropheryma , Doença de Whipple/diagnóstico , Doença de Whipple/tratamento farmacológico
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