title: Tropheryma whippelii as a cause of afebrile culture-negative endocarditis: the evolving spectrum of Whipple's disease.
abstract: With the advent of molecular diagnostics culture-negative endocarditis caused by the organism Tropheryma whippelii is an increasingly described entity. We describe two patients with afebrile, culture-negative endocarditis caused by T. whippelii who had neither the gastrointestinal nor arthritic manifestations of Whipple's disease. Whipple's disease is a systemic illness caused by the organism Tropheryma whippelii and is typically characterized by diarrhea, weight loss, and arthropathy [Clin. Microbiol. Rev. 2001;14:561-583; Medicine (Baltimore) 1997;76:170-184]. Whipple's endocarditis is relatively common in autopsy studies [Can. J. Cardiol. 1996;12:831-834] but has rarely been diagnosed before death. With the advent of molecular diagnostic tools such as the polymerase chain reaction (PCR), Tropheryma whippelii as a cause of culture-negative endocarditis has become increasingly recognized [Clin. Infect. Dis. 2001;33:1309-1316; Ann. Intern. Med. 1999;131:112-116; Infection 2001;29:44-47; Ann. Intern. Med. 2000;132:595]. With this increased recognition has come the realization that Whipple's endocarditis can occur without other common manifestations of Whipple's disease [Ann. Intern. Med. 1999;131:112-116; Infection 2001;29:44-47; Ann. Intern. Med. 2000;132:595]. We report here two cases of Whipple's endocarditis without discrete febrile illness, gastrointestinal manifestations, or arthritic manifestations, diagnosed by PCR of resected valvular material.
authors.affiliation: Department of Medicine, University Health Network, University of Toronto, Toronto, Ont., Canada.
authors.forename: David C
authors.initials: DC
authors.lastname: Richardson
authors.forename: Lori L
authors.initials: LL
authors.lastname: Burrows
authors.forename: Bryan
authors.initials: B
authors.lastname: Korithoski
authors.forename: Irving E
authors.initials: IE
authors.lastname: Salit
authors.forename: Jagdish
authors.initials: J
authors.lastname: Butany
authors.forename: Tirone E
authors.initials: TE
authors.lastname: David
authors.forename: John M
authors.initials: JM
authors.lastname: Conly
mesh_terms: D000368:Aged; D004697:Endocarditis, Bacterial / Q000382:microbiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D008061:Whipple Disease / Q000382:microbiology* / Q000628:therapy