Tropheryma whipplei in children with gastroenteritis

Abstract

Tropheryma whipplei, which causes Whipple disease, is found in human feces and may cause gastroenteritis. To show that T. whipplei causes gastroenteritis, PCRs for T. whipplei were conducted with feces from children 2-4 years of age. Western blotting was performed for samples from children with diarrhea who had positive or negative results for T. whipplei. T. whipplei was found in samples from 36 (15%) of 241 children with gastroenteritis and associated with other diarrheal pathogens in 13 (33%) of 36. No positive specimen was detected for controls of the same age (0/47; p = 0.008). Bacterial loads in case-patients were as high as those in patients with Whipple disease and significantly higher than those in adult asymptomatic carriers (p = 0.002). High incidence in patients and evidence of clonal circulation suggests that some cases of gastroenteritis are caused or exacerbated by T. whipplei, which may be co-transmitted with other intestinal pathogens.

Figure 1

Dendogram constructed by using unweighted pair group method with arithmetic mean and 4 highly variable genomic sequences (HVGS), showing phylogenetic diversity of 48 genotypes of 81 Tropheryma whipplei strains detected in 34 children with diarrhea (blue), 40 adult patients with Whipple disease (red), and 22 asymptomatic adult patients without Whipple disease (green) (including 11 sewer workers), Marseille, France. Sequences were concatenated to construct the dendrogram. Numbers in parentheses indicate number of genotyped samples for each category. Stars, France; crosses, Switzerland; circles, Germany; diamond, Italy; square, Austria; triangle, Canada; small circle, Comoros.

Figure 2

Western blot analysis of immunoglobulin (Ig) G and IgM against Tropheryma whipplei for children with gastroenteritis, Marseille, France. Total native antigens from T. whipplei were tested. A) Five patients without T. whipplei detected from stool samples but with positive Western blot serologic results. B) Eight patients infected with T. whipplei. MWM, molecular weight markers. Values on the right of each blot are in kilodaltons.