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Tropheryma whippelii DNA Is Rare in the Intestinal Mucosa of Patients without Other Evidence of Whipple Disease
- Matthias Maiwald, MD;
- Axel von Herbay, MD;
- David H. Persing, MD, PhD;
- P. Shawn Mitchell, MMSc;
- Manal F. Abdelmalek, MD;
- Jill N. Thorvilson, BS;
- David N. Fredricks, MD; and
- David A. Relman, MD
- From Stanford University, Stanford, and Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Pathologisches Institut der Universität, Heidelberg, Germany; and the Mayo Clinic, Rochester, Minnesota.
Abstract
Background: Little is known about the pathogenesis of Whipple disease, the reservoirs of Tropheryma whippelii, and the proportion of persons harboring the bacterium without “classic” intestinal abnormalities.
Objective: To assess the presence of T. whippelii in patients undergoing upper endoscopy for a variety of indications.
Design: Prospective and routine diagnostic examination of patients.
Setting: Three academic medical centers in California; Minnesota; and Heidelberg, Germany.
Patients: 342 patients undergoing endoscopy for evaluation of dyspepsia or possible peptic ulcer (group A, 173 patients), malabsorption (group B, 37 patients), or clinical suspicion of Whipple disease (group C, 132 patients).
Measurements: Small-intestinal biopsy specimens were tested by polymerase chain reaction for T. whippelii DNA and examined for histopathologic abnormalities.
Results: All patients with negative histologic findings also had negative results for T. whippelii DNA.
Conclusions: T. whippelii occurs only rarely in intestinal mucosa that lacks histopathologic evidence of Whipple disease. The human small intestinal mucosa is an unlikely reservoir for this organism.
Article and Author Information
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Grant Support: By the Deutsche Forschungsgemeinschaft, grants Ma1663/2-1 (Drs. Maiwald and von Herbay) and Ma1663/3-1 (Dr. Maiwald); the Lucille P. Markey Charitable Trust (Dr. Relman); the Donald and Delia Baxter Foundation (Dr. Relman); the National Institutes of Health, grant K11 AI01360 (Dr. Fredricks); and the American College of Gastroenterology (Dr. Abdelmalek).
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Requests for Single Reprints: David A. Relman, MD, Veterans Affairs Palo Alto Health Care System 154T, 3801 Miranda Avenue, Palo Alto, CA 94304; e-mail, relman{at}cmgm.stanford.edu.
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Current Author Addresses: Drs. Maiwald, Fredricks, and Relman: Veterans Affairs Palo Alto Health Care System 154T, 3801 Miranda Avenue, Palo Alto, CA 94304.
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Dr. von Herbay: Pathologisches Institut der Universität, Im Neuenheimer Feld 220, 69120 Heidelberg, Germany.
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Dr. Persing: Corixa Corp., Suite 200, Seattle Life Sciences Center, 1124 Columbia Street, Seattle, WA 98104.
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Mr. Mitchell and Ms. Thorvilson: Molecular Microbiology Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905.
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Dr. Abdelmalek: Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Box 100214, Gainesville, FL 32610.
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Author Contributions: Conception and design: M. Maiwald, A. von Herbay, D.H. Persing, D.A. Relman.
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Analysis and interpretation of the data: M. Maiwald, A. von Herbay, D.H. Persing, P.S. Mitchell, J.N. Thorvilson, D.N. Fredricks, D.A. Relman.
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Drafting of the article: M. Maiwald, A. von Herbay, D.H. Persing, D.A. Relman.
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Critical revision of the article for important intellectual content: M. Maiwald, A. von Herbay, D.H. Persing, M.F. Abdelmalek, D.A. Relman.
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Final approval of the article: M. Maiwald, D.H. Persing, D.N. Fredricks, D.A. Relman.
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Provision of study materials or patients: A. von Herbay, D.H. Persing, P.S. Mitchell, M.F. Abdelmalek, J.N. Thorvilson.
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Obtaining of funding: M. Maiwald, D.H. Persing, M.F. Abdelmalek, D.A. Relman.
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Administrative, technical, or logistic support: D.A. Relman.
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Collection and assembly of data: M. Maiwald, A. von Herbay, D.H. Persing, M.F. Abdelmalek, D.N. Fredricks, D.A. Relman.
- Copyright ©2004 by the American College of Physicians
