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Journal of Clinical Microbiology, October 2004, p. 4487-4493, Vol. 42, No. 10
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.10.4487-4493.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Tropheryma whipplei Infection of an Acellular Porcine Heart Valve Bioprosthesis in a Patient Who Did Not Have Intestinal Whipple's Disease

Jens Dreier,1* Florian Szabados,1 Axel von Herbay,2 Thilo Kröger,3 and Knut Kleesiek1

Institut für Laboratoriums- und Transfusionsmedizin, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen,1 Pathologisches Institut, Universität Heidelberg, Heidelberg,2 Gastroenterologische Facharztpraxis, Bünde, Germany3

Received 18 March 2004/ Returned for modification 19 May 2004/ Accepted 8 June 2004

Rare cases of culture-negative infective endocarditis are caused by Tropheryma whipplei, the uncommon bacterium of Whipple's disease. We evaluated an 80-year-old woman with valvular heart disease but without intestinal Whipple's disease. The diagnosis of aortic valve xenograft culture-negative infection with T. whipplei was established by multiple molecular assays and by electron microscopy. First, a PCR with broad-range primers identified the complete 16S ribosomal DNA of T. whipplei in bioprosthesis tissue. Novel real-time reverse transcription-PCR assays were developed to detect mRNAs encoding recently identified proteins determined from the T. whipplei genome, specifically Whipplei surface protein (TW113) and a DNA polymerase III subunit (TW727). The positive detection of mRNAs indicated the presence of metabolically active bacteria and suggested the viability of T. whipplei. The quantification of T. whipplei genome equivalents by real-time PCR indicated a high-density bacterial colonization of the valve tissue. Additionally, an ultrastructural examination revealed numerous rod-shaped bacteria consistent in size with T. whipplei in the extracellular collagen matrix of the bioprosthesis. We conclude that extracellular growth of T. whipplei can occur in the microenvironment of biological prosthetic valve tissue and that T. whipplei endocarditis can occur in the absence of intestinal Whipple's disease.

* Corresponding author. Mailing address: Institut für Laboratoriums- und Transfusionsmedizin, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Georgstrasse 11, D-32545 Bad Oeynhausen, Germany. Phone: 49-5731-97 1390. Fax: 49-5731-97 2307. E-mail: jdreier{at}hdz-nrw.de.

Journal of Clinical Microbiology, October 2004, p. 4487-4493, Vol. 42, No. 10
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.10.4487-4493.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Mancini, F., Sbaragli, S., Colivicchi, G., Cassone, A., Ciervo, A. (2009). Fourteen Years of Severe Arthralgia in a Man without Gastrointestinal Symptoms: Atypical Whipple's Disease. J. Clin. Microbiol. 47: 492-495 [Abstract] [Full Text]  
  • Vollmer, T., Piper, C., Kleesiek, K., Dreier, J. (2009). Lipopolysaccharide-Binding Protein: A New Biomarker for Infectious Endocarditis?. Clin. Chem. 55: 295-304 [Abstract] [Full Text]  
  • Marin, M., Munoz, P., Sanchez, M., del Rosal, M., Rodriguez-Creixems, M., Bouza, E., on behalf of Grupo de Apoyo al Manejo de la Endoca, (2007). Tropheryma whipplei Infective Endocarditis as the Only Manifestation of Whipple's Disease. J. Clin. Microbiol. 45: 2078-2081 [Abstract] [Full Text]  
  • Fenollar, F., Puechal, X., Raoult, D. (2007). Whipple's Disease. NEJM 356: 55-66 [Full Text]  


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