Cultivation of Tropheryma whipplei from cerebrospinal fluid.
Whipple disease (WD) is a systemic disorder caused by the bacterium Tropheryma whipplei. Since the recognition of a bacterial etiology in 1961, many attempts have been made to cultivate this bacterium in vitro. It was eventually isolated, in 2000, from an infected heart valve, in coculture with human fibroblasts. Here we report the isolation of 2 new strains of T. whipplei from cerebrospinal fluid (CSF) of 2 patients with intestinal WD but no neurological signs or symptoms. One culture-positive specimen was obtained before treatment; the other was obtained 12 months after discontinuation of therapy, at a time of intestinal remission. In both cases, 15 passages of the cultures were completed over 17 months. Bacterial growth was measured by quantitative polymerase chain reaction, which suggested a generation time of 4 days. Staining with YO-PRO nucleic-acid dye showed characteristic rod-shaped bacteria arranged in chains. Fluorescent in situ hybridization with a T. whipplei-specific oligonucleotide probe, a broad-range bacterial probe, and a nonspecific nucleic-acid stain indicated that all visible bacteria were T. whipplei. Scanning electron microscopy and transmission electron microscopy showed both intracellular and extracellular bacteria. This first isolation of T. whipplei from CSF provides clear evidence of viable bacteria in the central nervous system in individuals with WD, even after prolonged antibiotic therapy.
Maiwald
Matthias
M
Department of Microbiology, Stanford University School of Medicine, Stanford, California, USA.
von Herbay
Axel
A
Fredricks
David N
DN
Ouverney
Cleber C
CC
Kosek
Jon C
JC
Relman
David A
DA
D000192:Actinomycetales / Q000235:genetics / Q000254:growth & development* / Q000302:isolation & purification*; D000193:Actinomycetales Infections / Q000382:microbiology; D000368:Aged; D001583:Benzoxazoles; D002478:Cells, Cultured; D020806:Central Nervous System Bacterial Infections / Q000382:microbiology; D002555:Cerebrospinal Fluid / Q000382:microbiology*; D004269:DNA, Bacterial / Q000032:analysis; D005260:Female; D005347:Fibroblasts / Q000382:microbiology*; D005456:Fluorescent Dyes / Q000378:metabolism; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011806:Quinolinium Compounds; D012692:Serial Passage; D013194:Staining and Labeling / Q000379:methods; D008061:Whipple Disease / Q000382:microbiology*
D001583:Benzoxazoles; D004269:DNA, Bacterial; D005456:Fluorescent Dyes; D011806:Quinolinium Compounds; C089813:YO-PRO 1