Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France; IHU Méditerranée Infection, Marseille, France.
Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France; IHU Méditerranée Infection, Marseille, France.
Lancet Infect Dis. 2022 Oct;22(10):e280-e291. doi: 10.1016/S1473-3099(22)00128-1. Epub 2022 Apr 12.
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.
惠普尔病是由革兰阳性细菌特罗厄尔马拉色菌引起的慢性全身性疾病，主要影响胃肠道。过去二十年的数据大大增加了我们对特罗厄尔马拉色菌感染谱和认识的理解。尽管特罗厄尔马拉色菌似乎无处不在，但惠普尔病本身非常罕见。值得注意的是，原发性感染可能有症状，但大多数情况下会导致细菌清除和血清转换。然而，一些人无法清除细菌，导致持续无症状携带。在极少数情况下，可能与轻微的免疫缺陷有关，特罗厄尔马拉色菌的复制不受控制，表现为典型的惠普尔病或特罗厄尔马拉色菌局部感染。在这篇综述中，我们提供了特罗厄尔马拉色菌感染的全面概述，包括流行病学、临床表现、诊断和治疗。我们还提供了对宿主免疫反应和病理生理学的最新认识，并讨论了未来的研究途径，以解决特罗厄尔马拉色菌感染拼图中缺失的部分。
