Infectious Disease Compendium

Tropheryma whippeli

Microbiology

A gram positive rod related to actinomycetes.

Epidemiologic Risks

In the thrid world it is common in stools and is found in European sewers. So it is a widespread organism.

Maybe TNF-alpha therapy (PubMed).

Syndromes

Whipples Disease: a disseminated disease that presents with some combination of abdominal mass, abdominal pain, arthropathy (Rheumatic and Musculoskeletal (PubMed)), ascites, cardiac murmurs, chronic cough, diarrhea, fever, hepatomegaly, hyperpigmentation, hypotension, lymphadenopathy, myalgia, occult bleeding, peripheral edema, stoke and a wide variety of other neurologic symptoms (PubMed), splenomegaly, weight loss. I can't think of a Charmin reference.

In some series of endocarditis (PubMed), it is the most common cause of culture negative disease, it depends in how you make the diagnosis (PubMed) (Pubmed)

Pathology and PCR are the way to make the diagnosis, it can't be grown. Yet.

In West Africa, it causes fevers and cough in the cold season and can be found in the blood of 6% of febrile children (PubMed).

Treatment

Initial parenteral therapy: ceftriaxone, 2 g daily x 2 weeks.

Alternatives: meropenem OR penicillin PLUS streptomycin. Then long-term therapy (po): At least 1 year of, 160/800 mg twice daily.

Alternatives: doxycycline or a cephalosporin.

Notes