Lagier J-C, Fenollar F, Raoult D
Urmite CNRS-IRD UMR 6236, unité des Rickettsies, faculté de médecine, université de la Méditerranée, 27, boulevard Jean-Moulin, 13385 Marseille cedex 05, France.
Med Mal Infect. 2010 Jul;40(7):371-82. doi: 10.1016/j.medmal.2009.10.017. Epub 2010 Jan 15.
The first successful culture of Tropheryma whipplei made 10 years ago opened the way for identification of the bacterium and the development of many diagnostic tools. Phylogenetic analyses made it possible to classify it among Gram positive bacilli in the family of Actinomycetes, close to other ubiquitous bacteria of the environment. More than one century later, in the first description of Whipple's disease, T. whipplei was found to be responsible for a broad spectrum of clinical presentations. There is a variable prevalence according to areas or populations, and there are asymptomatic carriers of the bacterium. Whipple's disease is responsible mainly for arthralgia and diarrhea but can involve many organs. T. whipplei can also be responsible for neurological infection, blood culture-negative endocarditis, or uveitis. In addition to histological analyses, molecular tools help the clinician to prove these difficult diagnoses. Failure and relapse data and antibiotic susceptibility tests have allowed to determine a rational treatment.
10年前首次成功培养出的惠普尔嗜组织细胞菌，为该细菌的鉴定以及多种诊断工具的开发开辟了道路。系统发育分析使其能够被归类于放线菌科的革兰氏阳性杆菌中，与环境中其他常见细菌相近。一个多世纪后，在惠普尔病的首次描述中，发现惠普尔嗜组织细胞菌可导致广泛的临床表现。根据地区或人群不同，其患病率存在差异，且存在该细菌的无症状携带者。惠普尔病主要导致关节痛和腹泻，但可累及多个器官。惠普尔嗜组织细胞菌还可导致神经系统感染、血培养阴性的心内膜炎或葡萄膜炎。除了组织学分析外，分子工具有助于临床医生证实这些疑难诊断。失败和复发数据以及抗生素敏感性试验已有助于确定合理的治疗方案。
