Fenollar Florence, Amphoux Bernard, Raoult Didier
Université de la Méditerranée, Unité des Rickettsies, URMITE CNRS-IRD UMR 6236, Faculté de Médecine, Marseille, France.
Clin Infect Dis. 2009 Sep 1;49(5):717-23. doi: 10.1086/604717.
Tropheryma whipplei is a bacterium that causes Whipple disease. However, T. whipplei can be carried in the gut of asymptomatic people, which may lead to difficulty in the interpretation of positive stool sample test results.
This study included 60 patients with classic Whipple disease at the time of diagnosis and 26 T. whipplei carriers. Western blots testing for total immunoglobulin (Ig), IgG, IgM, and IgA were performed using glycosylated and deglycosylated T. whipplei. A blind test involving 10 patients and 10 carriers was performed. Sera samples from 32 treated patients were tested for total immunoglobulin.
Total immunoglobulin from patients with classic Whipple disease exhibited either a lack of reaction (23 [38%] of 60 patients) or a decrease in reaction (33 [55%] of 60 patients) with a T. whipplei glycoprotein of 110 kDa after deglycosylation. Only 4 patients exhibited a stronger immune response than that which was observed for carriers (21 [81%] of 26 carriers). Five carriers presented a response profile similar to that for the patients. IgM (4 [7%] of 60 patients) or IgA (1 [2%] of 60 patients) responses were rarely observed but were exclusive to patients. Overall, results were consistent and reproducible. Antibiotic therapy had no effect on the serological profiles of the patients.
Western blot serology is useful to distinguish between carriers and patients; paradoxical responses of the antibodies were investigated.
惠普尔嗜组织菌是一种可引发惠普尔病的细菌。然而，该菌可在无症状人群的肠道中携带，这可能导致粪便样本检测结果呈阳性时难以解读。
本研究纳入了60例确诊时患有经典惠普尔病的患者以及26例惠普尔嗜组织菌携带者。使用糖基化和去糖基化的惠普尔嗜组织菌对总免疫球蛋白（Ig）、IgG、IgM和IgA进行蛋白质印迹检测。对10例患者和10例携带者进行了盲测。对32例接受治疗的患者的血清样本进行了总免疫球蛋白检测。
经典惠普尔病患者的总免疫球蛋白在去糖基化后，与110 kDa的惠普尔嗜组织菌糖蛋白反应时，要么无反应（60例患者中的23例[38%]），要么反应减弱（60例患者中的33例[55%]）。只有4例患者表现出比携带者更强的免疫反应（26例携带者中的21例[81%]）。5例携带者呈现出与患者相似的反应模式。IgM反应（60例患者中的4例[7%]）或IgA反应（60例患者中的1例[2%]）很少见，但仅见于患者。总体而言，结果一致且可重复。抗生素治疗对患者的血清学特征无影响。
蛋白质印迹血清学有助于区分携带者和患者；对抗体的矛盾反应进行了研究。
