Tropheryma whipplei bacteremia during fever in rural West Africa

Abstract

Background: Tropheryma whipplei not only causes Whipple disease but also is an emerging pathogen associated with gastroenteritis and pneumonia that is commonly detected in stool samples in rural West Africa. We investigated the role of T. whipplei in febrile patients from rural Senegal who had a negative test result for malaria.

Methods: From November 2008 through July 2009, we conducted a prospective study in 2 Senegalese villages; 204 blood specimens from febrile patients were collected. DNA extraction of whole-blood samples collected by finger pricks with a lancet stick was performed in Senegal; elution and quantitative polymerase chain reaction assays for T. whipplei were performed in France. In April 2009, we conducted a screening to look for the presence of T. whipplei in the saliva and stools of the overall population. Blood from French patients with chronic T. whipplei in stool samples was also analyzed.

Results: The presence of T. whipplei DNA was detected in blood from 13 (6.4%) of 204 tested patients, mostly in children and in December and January. None of the French carriers tested positive. The patients with T. whipplei bacteremia presented with fever (13 patients), cough (10), thirst (8), fatigue (7), rhinorrhea (6), and sleep disorders (5). Cough and sleep disorders were significantly more frequent in febrile carriers than in the 191 febrile episodes without T. whipplei bacteremia (P = .002 and .005, respectively). No correlation was observed between the presence of T. whipplei in the stools and saliva and bacteremia.

Conclusions: Our findings suggest that T. whipplei is an agent of unexplained cold season fever with cough in rural West Africa.