Cardiac valves in patients with Whipple endocarditis: microbiological, molecular, quantitative histologic, and immunohistochemical studies of 5 patients.
The pathological features of Whipple endocarditis, which is caused by Tropheryma whipplei, were histologically evaluated in cardiac valves from 5 patients. We used quantitative image analysis to compare the valvular fibrosis, calcifications, vegetations, inflammation, and vascularization due to Whipple endocarditis with those due to non-Whipple endocarditis and degenerative valves. We also studied the presence of T. whipplei in valves by immunohistochemical analysis, culture, and polymerase chain reaction (PCR). In histologic analysis, Whipple endocarditis was characterized by significant fibrosis, a lack of calcifications, slight inflammation and vascularization, and vegetations of intermediate size. Inflammatory infiltrates consisted mainly of foamy macrophages and lymphocytes. We found that the detection of T. whipplei in cardiac valves, by immunohistochemical analysis, was correlated with the detection of the bacterium by culture and PCR. We report, for the first time, the immunodetection of T. whipplei in a surgically removed arterial embolus. Pathological and immunohistologic analyses may contribute to the diagnosis of Whipple endocarditis.
Unite des Rickettsies, Centre National de la Recherche Scientifique, Unite de Mixte de Recherche 6020, Institut Federatif Recherche 48, Faculte de Medecine, Universite de la Mediterranee, Marseille, France.
Hubert
H
Lepidi
Florence
F
Fenollar
J Stephen
JS
Dumler
Valérie
V
Gauduchon
Lara
L
Chalabreysse
Antoine
A
Bammert
Marie-France
MF
Bonzi
Françoise
F
Thivolet-Béjui
François
F
Vandenesch
Didier
D
Raoult
D000328:Adult; D001021:Aortic Valve / Q000382:microbiology / Q000473:pathology; D003470:Culture Media; D004697:Endocarditis, Bacterial / Q000382:microbiology / Q000473:pathology*; D006350:Heart Valve Prosthesis / Q000382:microbiology; D006351:Heart Valves / Q000382:microbiology* / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000382:microbiology / Q000473:pathology; D016133:Polymerase Chain Reaction; D014208:Treponema / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D008061:Whipple Disease / Q000382:microbiology / Q000473:pathology*
D003470:Culture Media