title: Tropheryma whipplei endocarditis in Spain: Case reports of 17 prospective cases.
abstract: Tropheryma whipplei endocarditis is an uncommon condition with very few series and <90 cases reported in the literature. The aim of the study was to analyze the epidemiological, clinical, and outcome characteristics of 17 cases of T. whipplei endocarditis recruited in our country from a multicentric cohort from 25 Spanish hospitals from the Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España.From a total of 3165 cases included in the cohort, 14.2% were diagnosed of blood culture negative endocarditis (BCNE) and 3.5% of these had T. whipplei endocarditis. This condition was more frequent in men. The average age was 60.3 years. Previous cardiac condition was present in 35.3% of the cases. The main clinical manifestation was cardiac failure (76.5%) while fever was only present in the 35.3%. Ecocardiography showed vegetations in 64.7% of patients. Surgery was performed in all but 1 cases and it allowed the diagnosis when molecular assays were performed. A broad range rRNA 16S polymerase chain reaction was used for first instance in all laboratories and different specific targets for T. whipplei were employed for confirmation. A concomitant Whipple disease was diagnosed in 11.9% of patients. All patients received specific antimicrobial treatment for at least 1 year, with no relapse and complete recovery.T. whipplei endocarditis is an uncommon condition with an atypical presentation that must be considered in the diagnosis of BCNE. The prognosis is very good when an appropriate surgical management and antimicrobial-specific treatment is given.
authors.affiliation: aDepartamento de Enfermedades Infecciosas, Hospital San Pedro-Centro de Investigación Biomédica de La Rioja (CIBIR) bDepartamento de Enfermedades Infecciosas, Hospital San Pedro, Logroño cServicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid dServicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander eUnidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Universidad del País Vasco fUnidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Bilbao gServicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo hUnidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla iServicio de Microbiología y Parasitología, Hospital Clinic de Barcelona, Barcelona jServicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona kServicio de Enfermedades Infecciosas, Hospital Universitario de Canarias, Tenerife lServicio de Enfermedades Infecciosas, Hospital Universitario Donosti, San Sebastián mServicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid nServicio de Anatomía Patológica, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
authors.forename: Lara
authors.initials: L
authors.lastname: García-Álvarez
authors.forename: María Mercedes
authors.initials: MM
authors.lastname: Sanz
authors.forename: Mercedes
authors.initials: M
authors.lastname: Marín
authors.forename: MCarmen
authors.initials: M
authors.lastname: Fariñas
authors.forename: Miguel
authors.initials: M
authors.lastname: Montejo
authors.forename: Josune
authors.initials: J
authors.lastname: Goikoetxea
authors.forename: Raquel
authors.initials: R
authors.lastname: Rodríguez García
authors.forename: Arístides
authors.initials: A
authors.lastname: de Alarcón
authors.forename: Manuel
authors.initials: M
authors.lastname: Almela
authors.forename: Núria
authors.initials: N
authors.lastname: Fernández-Hidalgo
authors.forename: María Del Mar
authors.initials: Mdel M
authors.lastname: Alonso Socas
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Goenaga
authors.forename: Enrique
authors.initials: E
authors.lastname: Navas
authors.forename: Luis
authors.initials: L
authors.lastname: Vicioso
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Oteo
mesh_terms: D000193:Actinomycetales Infections; D000368:Aged; D004697:Endocarditis, Bacterial / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013030:Spain; D054851:Tropheryma