Whipple's disease and Tropheryma whipplei infections: from bench to bedside. Issue 10 (October 2022)

• Record Type: Journal Article
• Authors: Boumaza, Asma; Ben Azzouz, Eya; Arrindell, Jeffrey; Lepidi, Hubert; Mezouar, Soraya; Desnues, Benoit
• Is Part Of: Lancet infectious diseases. Volume 22:Issue 10(2022)
• Page Start: e280
• Page End: e291
• Publication Date: 2022-10
• Subjects: Communicable diseases -- Periodicals; Infection -- Periodicals; Communicable Diseases -- Periodicals; Infection -- Periodicals; Maladies infectieuses -- Périodiques; Infection -- Périodiques; Communicable diseases; Infection; Periodicals; 616.905
• DOI: 10.1016/S1473-3099(22)00128-1
• Languages: English
• ISSNs: 1473-3099

Abstract

Summary: Whipple's disease is a chronic and systemic disease caused by the Gram-positive bacterium Tropheryma whipplei that primarily affects the gastrointestinal tract. Data from the last two decades have substantially increased our knowledge of the spectrum and our understanding of T whipplei infections. Although T whipplei seems ubiquitously present in the environment, Whipple's disease itself is very rare. Remarkably, primary infections can be symptomatic, but most cases result in bacterial clearance and seroconversion. However, some individuals are unable to clear the bacterium leading to persistence and asymptomatic carriage. In very rare cases, which might be associated with a subtle immune defect, T whipplei replication is uncontrolled and manifests as classical Whipple's disease or T whipplei localised infections. In this review, we provide a comprehensive outline of T whipplei infection, including the epidemiology, clinical manifestations, diagnosis, and treatment. We also provide an up-to-date overview of our understanding of the host immune response and pathophysiology and discuss future research avenues to resolve the lacking pieces of the puzzle of T whipplei infections.