Whipple's disease: staging and monitoring by cytology and polymerase chain reaction analysis of cerebrospinal fluid.
OBJECTIVE
Diagnostic procedures in Whipple's disease usually focus on the intestine, but symptomatic central nervous system involvement is a major threat for patients. The aim of this study was to determine the diagnostic value of cerebrospinal fluid (CSF) analysis.


METHODS
A total of 39 CSF samples and 2 brain biopsy specimens that were obtained from 24 patients with Whipple's disease at various intervals after diagnosis were examined. Five patients presented with neurological symptoms, 3 of them as relapses after therapy. Thirty-two CSF samples were examined by polymerase chain reaction for Tropheryma whippelli and 20 CSF samples by cytology. Brain biopsy specimens were examined histologically.


RESULTS
Positive results were obtained in 4 of 5 patients (80%) with neurological symptoms, in 7 of 10 patients (70%) without neurological symptoms examined before therapy, and in 3 of 11 patients (27%) without neurological symptoms studied during or after therapy. Conversion from positive to negative was observed in 4 patients after antibiotic treatment.


CONCLUSIONS
Testing of CSF in Whipple's disease yields a high rate of positive results, even in patients without neurological symptoms. Examination of CSF is therefore potentially useful for initial staging and for monitoring of the efficiency of therapy.
von Herbay
A
A
Institute of Pathology, University of Heidelberg, Germany. AxelvvonvHerbay@krzmall.krz.uniheidelberg.de
Ditton
H J
HJ
Schuhmacher
F
F
Maiwald
M
M
D039903:Actinobacteria / Q000235:genetics* / Q000302:isolation & purification; D000193:Actinomycetales Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000473:pathology*; D000196:Actinomycosis / Q000175:diagnosis / Q000235:genetics / Q000473:pathology; D000328:Adult; D001483:Base Sequence; D001706:Biopsy / Q000379:methods; D001921:Brain / Q000473:pathology*; D002490:Central Nervous System / Q000473:pathology / Q000503:physiopathology; D002555:Cerebrospinal Fluid / Q000166:cytology* / Q000382:microbiology; D004269:DNA, Bacterial / Q000134:cerebrospinal fluid* / Q000235:genetics; D018450:Disease Progression; D004591:Electrophoresis, Polyacrylamide Gel; D005260:Female; D016259:Genes, myc / Q000235:genetics; D006801:Humans; D007422:Intestines / Q000737:chemistry / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D008061:Whipple Disease / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000473:pathology*
D004269:DNA, Bacterial