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Titolo:
Whipple's disease and "Tropheryma whippelii"
Autore:
Dutly, F; Altwegg, M;
Indirizzi:
Univ Zurich, Dept Med Microbiol, CH-8028 Zurich, Switzerland Univ Zurich Zurich Switzerland CH-8028 biol, CH-8028 Zurich, Switzerland
Titolo Testata:
CLINICAL MICROBIOLOGY REVIEWS
fascicolo: 3, volume: 14, anno: 2001,
pagine: 561 -
SICI:
0893-8512(200107)14:3<561:WDA"W>2.0.ZU;2-V
Fonte:
ISI
Lingua:
ENG
Soggetto:
POLYMERASE-CHAIN-REACTION; CENTRAL-NERVOUS-SYSTEM; RIBOSOMAL-RNA GENE; PROGRESSIVE SUPRANUCLEAR PALSY; MYCOBACTERIUM-AVIUM COMPLEX; AORTIC-VALVE ENDOCARDITIS; BLOOD MONONUCLEAR-CELLS; TERM FOLLOW-UP; ANTIBIOTIC-TREATMENT; PERIPHERAL-BLOOD;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Life Sciences
Citazioni:
210
Recensione:
Indirizzi per estratti:
Indirizzo: Dutly, F Inst Med & Mol Diagnost AG, IMD, Rautistr 13, CH-8047 Zurich, Switzerland Inst Med & Mol Diagnost AG Rautistr 13 Zurich Switzerland CH-8047
Citazione:
F. Dutly e M. Altwegg, "Whipple's disease and "Tropheryma whippelii"", CLIN MICROB, 14(3), 2001, pp. 561

Abstract

Whipple's disease is a rare bacterial infection that may involve any organsystem in tire body. It occurs primarily in Caucasian males older. than 40years. The gastrointestinal tract is the most frequently involved organ, with manifestations such as abdominal pain, malabsorption syndrome with diarrhea, and weight loss. Other signs include low-grade fever; lymphadenopathy, skin hyperpigmentation, endocarditis, pleuritis, seronegative arthritis, uveitis, spondylodiscitis, and neurological manifestations, and these signsmay occur in the absence of gastrointestinal manifestations. Due to the wide variability of manifestations, clinical diagnosis is very difficult and is often made only years or even decades after the initial symptoms have appeared. Trimethoprim-sulfamethoxazole for at least 1 year is usually considered adequate to eradicate the infection. The microbiological diagnosis of this insidious disease is rendered difficult by the virtual lack of cultureand serodiagnostic methods. It is usually based on the demonstration of periodic acid-Schiff-positive particles in infected tissues and/or the presence of bacteria with an unusual trilaminar cell wall ultrastructure by electron microscopy. Recently the Whipple bacteria have been characterized at the molecular level by amplification of their 16S rRNA gene(s). Phylogenetic analysis of these sequences revealed a new bacterial species related to theactinomycete branch which was named "Tropheryma whippelli. " Based on its unique 16S ribosomal DNA (rDNA) sequence species-specific primers were selected for the detection of the organism in clinical specimens by PCR. This technique is currently used as one of the standard methods for establishing the diagnosis of Whipple's disease. Specific and broad-spectrum PCR amplifications mainly but not exclusively from extraintestinal specimens have significantly improved diagnosis, being more sensitive than histopathologic analysis. However; "T. whippelii" DNA has also been found in persons without clinical and histological evidence of Whipple's disease. It is unclear whether these patients are true asymptomatic carriers or whether differences in virulence exist among strains of "T. whippelii" that might account for the variable clinical manifestations. So far, six different "T. whippelii" subtypes have been found by analysis of their 16S-23S rDNA spacer region. Further studies of the pathogen "T. whippelii" as well as the host immune response are needed to fully understand this fascinating disease. The recent cultivation of the organisms is a promising major step in this direction.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 21/01/20 alle ore 06:52:34