Correspondence

Tropheryma whipplei Circulating in Blood Monocytes

N Engl J Med 2001; 345:548August 16, 2001

Article

To the Editor:

Whipple's disease is an infection that affects primarily the intestine, but some cases involve the heart valve, the peripheral lymph nodes, the joints, and the central nervous system.1 Recently, the establishment of Tropheryma whipplei (formerly T. whippelii, the causative agent of Whipple's disease)2 in culture allowed the generation of antibodies against the bacterium3 that we used for immunostaining the valve2 or duodenal specimen3 of infected patients. Here, we report the immunodetection of T. whipplei in the circulating monocytes of a patient with untreated Whipple's disease.

A 70-year-old man was hospitalized in December 2000 for fatigue, weight loss, and a left subclavicular lymphadenopathy. Polymerase chain reaction and immunostaining of biopsy specimens of the lymph node and the duodenum4 confirmed a diagnosis of Whipple's disease.3 Monocytes were separated from blood with the Ficoll gradient method and purified from other peripheral-blood mononuclear cells by adhesion on a glass slide, as previously described.5 Then, adherent monocytes were fixed in acetone and air-dried. To detect the presence of T. whipplei in monocytes by immunocytochemical testing, we used a previously described method,3 and three healthy donors served as controls. T. whipplei was identified by immunostaining as granular, immunopositive material in the cytoplasm of 6 percent of the monocyte (Figure 1Figure 1 Tropheryma whipplei, as Detected by Immunocytochemical Staining, as Granular, Immunopositive Material in the Cytoplasm of a Blood Monocyte.).

Our finding explains how several viscera can be infected through the circulation of infected blood monocytes and may prove useful in devising a diagnostic tool.

Didier Raoult, M.D., Ph.D.
Hubert Lepidi, M.D., Ph.D.
Faculté de Médecine, 13385 Marseilles, France
didier.raoult@medecine.univ-mrs.fr

Jean Robert Harle, M.D.
Hôpital de la Conception, 13385 Marseilles, France

5 References

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   Raoult D, La Scola B, Lecocq P, Lepidi H, Fournier PE. Culture and immunological detection of Tropheryma whippelii from the duodenum of a patient with Whipple disease. JAMA 2001;285:1039-1043
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   Dellacasagrande J, Ghigo E, Capo C, Raoult D, Mege JL. Coxiella burnetii survives in monocytes from patients with Q fever endocarditis: involvement of tumor necrosis factor. Infect Immun 2000;68:160-164
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Citing Articles (14)

Citing Articles

1. 1

   V. Moos, T. Schneider. (2011) Changing paradigms in Whipple’s disease and infection with Tropheryma whipplei. European Journal of Clinical Microbiology & Infectious Diseases 30:10, 1151-1158
   CrossRef

2. 2

   Jean-Christophe Lagier, Hubert Lepidi, Didier Raoult, Florence Fenollar. (2010) Systemic Tropheryma whipplei. Medicine 89:5, 337-345
   CrossRef

3. 3

   Quentin Leroy, Didier Raoult. (2010) Review of microarray studies for host–intracellular pathogen interactions. Journal of Microbiological Methods 81:2, 81-95
   CrossRef

4. 4

   Didier Raoult, J. Stephen Dumler. 2010. Rickettsia and Orienta. .
   CrossRef

5. 5

   X. Puéchal. (2009) Maladie de Whipple. La Revue de Médecine Interne 30:3, 233-241
   CrossRef

6. 6

   Peter Jackuliak, Tomas Koller, Lahim Baqi, Lukas Plank, Zora Lasabova, Gabriel Minarik, Juraj Payer. (2008) Whipple’s Disease—Generalized Stage. Digestive Diseases and Sciences 53:12, 3250-3258
   CrossRef

7. 7

   Thomas Schneider, Verena Moos, Christoph Loddenkemper, Thomas Marth, Florence Fenollar, Didier Raoult. (2008) Whipple's disease: new aspects of pathogenesis and treatment. The Lancet Infectious Diseases 8:3, 179-190
   CrossRef

8. 8

   Malgorzata Kowalczewska, Didier Raoult. (2007) Advances in Tropheryma whipplei research: the rush to find biomarkers for Whipple’s disease. Future Microbiology 2:6, 631-642
   CrossRef

9. 9

   Pedro Bermejo, Aurora Burgos. (2006) Enfermedad de Whipple y sistema nervioso central. Medicina Clínica 127:10, 379-385
   CrossRef

10. 10

    Malgorzata Kowalczewska, Florence Fenollar, Daniel Lafitte, Didier Raoult. (2006) Identification of candidate antigen in Whipple's disease using a serological proteomic approach. PROTEOMICS 6:11, 3294-3305
    CrossRef

11. 11

    A. Kalt, T. Schneider, S. Ring, J. Hoffmann, M. Zeitz, A. Stallmach, D. H. Persing, T. Marth. (2006) Decreased levels of interleukin-12p40 in the serum of patients with Whipple’s disease. International Journal of Colorectal Disease 21:2, 114-120
    CrossRef

12. 12

    D.G James, M.C.I Lipman. (2002) Whipple's disease: a granulomatous masquerader. Clinics in Chest Medicine 23:2, 513-519
    CrossRef

13. 13

    Thomas Marth. (2001) The diagnosis and treatment of whipple’s disease. Current Allergy and Asthma Reports 1:6, 566-571
    CrossRef

14. 14

    Florence Fenollar, Didier Raoult. (2001) Molecular techniques in Whipple's disease. Expert Review of Molecular Diagnostics 1:3, 299-309
    CrossRef