title: Tropheryma whipplei DNA in bronchoalveolar lavage samples: a case control study.
abstract: Tropheryma whipplei, the causative bacterium of Whipple's disease, can cause acute pneumonia. We performed a case-control study including patients with T. whipplei in bronchoalveolar lavages (BALs) and controls in order to compare patients' clinical statuses. We tested T. whipplei PCR from January 2013 to December 2014, in all the 1438 BALs in Marseille, France. Controls were hospitalized in the same unit during the same period and were comparable in age and sex. Eighty-eight BALs (6.1%) were positive for T. whipplei and 58 patients had pneumonia. Sixty-four patients were male with a mean age of 50.5 years. T. whipplei was commonly associated with aspiration pneumonia (18/88 patients compared with 6/88 controls, p 0.01) and was detected as a unique pathogen in nine cases. Overall, no difference was observed regarding immunocompromised status. Nevertheless, the six AIDS-infected patients in the T. whipplei group had a significantly lower CD4 level than the five AIDS-infected patients in the control group (49 vs. 320/mm3, p 0.01); in addition, five patients were treated with tumour necrosis factor alpha inhibitors (including three treated by monocolonal antibodies and two with soluble receptor) compared with none of the controls (p 0.03). Pneumocystis jirovecii was frequently associated with the T. whipplei group (7/88 vs. 0/88 in control group), Pseudomonas aeruginosa was only detected in the control group (8/88). This study adds evidence for a causative role of T. whipplei in pneumonia. In the future, an experimental model of pneumonia induced by T. whipplei will prove its role in pneumonia.
authors.affiliation: Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France; IHU Méditerranée Infection, Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Service de Maladies Infectieuses et Tropicales, CHU Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France.
authors.forename: J-C
authors.initials: JC
authors.lastname: Lagier
authors.affiliation: Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France; APHM, CHU Nord, Service de Réanimation, Détresse Respiratoire et Infections Sévères, Marseille, France.
authors.forename: L
authors.initials: L
authors.lastname: Papazian
authors.affiliation: Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France.
authors.forename: F
authors.initials: F
authors.lastname: Fenollar
authors.affiliation: Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France.
authors.forename: S
authors.initials: S
authors.lastname: Edouard
authors.affiliation: Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France; APHM, CHU Nord, Service de Réanimation, Détresse Respiratoire et Infections Sévères, Marseille, France.
authors.forename: C
authors.initials: C
authors.lastname: Melenotte
authors.affiliation: APHM, CHU Nord, APHM, Hôpital Nord, Department of Thoracic Oncology - Pleural Diseases - Interventional Pulmonology, Marseille, France.
authors.forename: S
authors.initials: S
authors.lastname: Laroumagne
authors.affiliation: APHM, CHU Timone enfants, Service d'Hématologie, Marseille, France.
authors.forename: G
authors.initials: G
authors.lastname: Michel
authors.affiliation: APHM, CHU Nord, Service de Réanimation, Marseille, France.
authors.forename: C
authors.initials: C
authors.lastname: Martin
authors.affiliation: APHM, CHU Timone, Service de Réanimation, Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Gainnier
authors.affiliation: INSERM, UMR912 (SESSTIM) Aix Marseille Université, UMR_S912, IRD ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte-d'Azur, Marseille, France.
authors.forename: C
authors.initials: C
authors.lastname: Lions
authors.affiliation: INSERM, UMR912 (SESSTIM) Aix Marseille Université, UMR_S912, IRD ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte-d'Azur, Marseille, France.
authors.forename: P
authors.initials: P
authors.lastname: Carrieri
authors.affiliation: IHU Méditerranée Infection, Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Service de Maladies Infectieuses et Tropicales, CHU conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France.
authors.forename: A
authors.initials: A
authors.lastname: Stein
authors.affiliation: Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France; IHU Méditerranée Infection, Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Service de Maladies Infectieuses et Tropicales, CHU Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France.
authors.forename: P
authors.initials: P
authors.lastname: Brouqui
authors.affiliation: Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France. Electronic address: didier.raoult@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Raoult
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000032:analysis*; D005260:Female; D005602:France; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000382:microbiology*; D054851:Tropheryma / Q000235:genetics*; D008061:Whipple Disease / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D004269:DNA, Bacterial
keywords: Bronchoalveolar lavage; Pneumocystis jirovecii; Pneumonia; Pseudomonas aeruginosa; Tropheryma whipplei