title: Relapse of Tropheryma whipplei endocarditis treated by trimethoprim/sulfamethoxazole, cured by hydroxychloroquine plus doxycycline.
abstract: The best treatment for Tropheryma whipplei infections is controversial. We report a patient who suffered from T. whipplei aortic native valve endocarditis that relapsed despite surgery and four weeks of intravenous ceftriaxone followed by several months of oral trimethoprim/sulfamethoxazole. Cure was achieved after replacement of the prosthesis with a homograft and 18 months of oral doxycycline-hydroxychloroquine. We discuss the need for a change in treatment guidelines for T. whipplei infections.
authors.affiliation: Service of Infectious Diseases, Department of Medical Specialties, University Hospitals Geneva, Switzerland; Bacteriology laboratory, Department of Laboratories and Genetic Medicine, University Hospitals Geneva, Switzerland. Electronic address: stephane.emonet@hcuge.ch.
authors.forename: Stephane
authors.initials: S
authors.lastname: Emonet
authors.affiliation: Internal Medicine Department, University Hospitals Geneva, Switzerland.
authors.forename: Timothee
authors.initials: T
authors.lastname: Wuillemin
authors.affiliation: Service of Infectious Diseases, Department of Medical Specialties, University Hospitals Geneva, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Harbarth
authors.affiliation: Service of Infectious Diseases, Department of Medical Specialties, University Hospitals Geneva, Switzerland.
authors.forename: Nasstasja
authors.initials: N
authors.lastname: Wassilew
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, University Hospitals Geneva, Switzerland.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Cikirikcioglu
authors.affiliation: Service of Infectious Diseases, Department of Medical Specialties, University Hospitals Geneva, Switzerland; Bacteriology laboratory, Department of Laboratories and Genetic Medicine, University Hospitals Geneva, Switzerland.
authors.forename: Jacques
authors.initials: J
authors.lastname: Schrenzel
authors.affiliation: Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, 13005 Marseille, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lagier
authors.affiliation: Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, 13005 Marseille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
authors.affiliation: Service of Infectious Diseases, Department of Medical Specialties, University Hospitals Geneva, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: van Delden
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001021:Aortic Valve / Q000382:microbiology; D002443:Ceftriaxone / Q000627:therapeutic use; D004318:Doxycycline / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000188:drug therapy*; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D054851:Tropheryma / Q000302:isolation & purification; D008061:Whipple Disease / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D006886:Hydroxychloroquine; D002443:Ceftriaxone; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D004318:Doxycycline
keywords: Doxycycline; Endocarditis; Guidelines; Hydroxychloroquine; Trimethoprim/sulfamethoxazole; Whipple's disease