title: Whipple's disease: staging and monitoring by cytology and polymerase chain reaction analysis of cerebrospinal fluid.
abstract: 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.
authors.affiliation: Institute of Pathology, University of Heidelberg, Germany. AxelvvonvHerbay@krzmall.krz.uniheidelberg.de
authors.forename: A
authors.initials: A
authors.lastname: von Herbay
authors.forename: H J
authors.initials: HJ
authors.lastname: Ditton
authors.forename: F
authors.initials: F
authors.lastname: Schuhmacher
authors.forename: M
authors.initials: M
authors.lastname: Maiwald
mesh_terms: 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*
chemical_list: D004269:DNA, Bacterial