Infectious Disease Compendium

Tropheryma whippeli


A gram-positive rod related to actinomycetes.

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

Usually a small bowel biopsy is the organ of choice but for isolated CNS or arthritis, the bowel is often negative and the PCR needs to be sent of CSF or synovial fluid (PubMed).

Epidemiologic Risks

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

Maybe TNF-alpha therapy (PubMed).

Much more common in men.


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.

The most common symptoms are diarrhea, abdominal pain and malabsorption, weight loss, and arthralgias then neurologic symptoms.

Unexplained intermittent seronegative peripheral polyarthritis, including those without constitutional symptoms, should be tested for Whipple's (PubMed).

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).

With endocarditis, the aortic valve is most commonly involved, mutliple valves not uncommon, the patient may be afebrile, and inflammatory markers may be normal (PubMed).

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).


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

Doxycycline 200 mg a day and hydroxychloroquine 200 mg tid for at least a year and a half (NEJM Review) may be best.

Alternatives: meropenem OR penicillin PLUS streptomycin.

Then long-term therapy (po): At least 1 year of, tmp/sulfa 160/800 mg twice daily.

Alternatives: doxycycline or a cephalosporin.


Curious Cases

Relevant links to my Medscape blog

More Questions Than Answers

Last Update: 01/21/19.