title: [Tropheryma whipplei infection. Colonization, self-limiting infection and Whipple's disease].
abstract: Whipple's disease is a multisystemic infection caused by the ubiquitous bacterium Tropheryma whipplei. Immunological host factors enable classical Whipple's disease; however, T. whipplei can be found in three other clinical conditions: healthy colonization, self-limiting infections, and isolated endocarditis. The genetic predisposition of the host rather than the genotype of the bacterium influences the infection. Modern diagnostic methods elucidate the many facets of Whipple's disease. In particular, isolated T. whipplei-induced infective endocarditis can only be diagnosed after valve resection. The sole treatment of Whipple's disease evaluated prospectively comprises intravenous induction therapy with ceftriaxone or meropenem, followed by continuation therapy with oral TMP-SMX. In the case of Immune reconstitution inflammatory syndrome (IRIS) or inflammatory lesions of the CNS in the setting of Whipple's disease, additional treatment with corticosteroids should be considered to avoid severe tissue damage.
authors.affiliation: Medizinische Klinik I, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland. verena.moos@charite.de
authors.forename: V
authors.initials: V
authors.lastname: Moos
authors.forename: C
authors.initials: C
authors.lastname: Loddenkemper
authors.forename: T
authors.initials: T
authors.lastname: Schneider
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001706:Biopsy; D002353:Carrier State; D002443:Ceftriaxone / Q000627:therapeutic use; D002493:Central Nervous System Diseases / Q000473:pathology; D002648:Child; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004386:Duodenum / Q000473:pathology; D004697:Endocarditis, Bacterial / Q000235:genetics / Q000473:pathology; D005773:Gastroscopy; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006351:Heart Valves / Q000473:pathology; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000473:pathology; D000077731:Meropenem; D013845:Thienamycins / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D054851:Tropheryma; D008061:Whipple Disease / Q000188:drug therapy / Q000235:genetics / Q000473:pathology*
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D013845:Thienamycins; D002443:Ceftriaxone; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000077731:Meropenem