[From Whipple's disease to Tropheryma whipplei infections]

Abstract

The first successful culture of Tropheryma whipplei made 10 years ago opened the way for identification of the bacterium and the development of many diagnostic tools. Phylogenetic analyses made it possible to classify it among Gram positive bacilli in the family of Actinomycetes, close to other ubiquitous bacteria of the environment. More than one century later, in the first description of Whipple's disease, T. whipplei was found to be responsible for a broad spectrum of clinical presentations. There is a variable prevalence according to areas or populations, and there are asymptomatic carriers of the bacterium. Whipple's disease is responsible mainly for arthralgia and diarrhea but can involve many organs. T. whipplei can also be responsible for neurological infection, blood culture-negative endocarditis, or uveitis. In addition to histological analyses, molecular tools help the clinician to prove these difficult diagnoses. Failure and relapse data and antibiotic susceptibility tests have allowed to determine a rational treatment.