Gastroenterology
Volume 138, Issue 2 , Pages 478-486 , February 2010

Efficacy of Ceftriaxone or Meropenem as Initial Therapies in Whipple's Disease

  • Gerhard E. Feurle

      Affiliations

    • DRK Krankenhaus, Neuwied, Germany
    • Corresponding Author InformationReprint requests Address requests for reprints to: Gerhard E. Feurle, MD, DRK Krankenhaus Neuwied, Marktstraße 104, 56564 Neuwied, Germany. fax: (49) 2631-981492
    • ,
  • Natascha S. Junga

      Affiliations

    • St. Josef Krankenhaus, Braunau, Austria
    • ,
  • Thomas Marth

      Affiliations

    • Krankenhaus Maria Hilf, Daun, Germany

Received 30 June 2009 ,Accepted 19 October 2009.

References 

  1. Whipple GH. A hitherto undescribed disease characterized anatomically by deposits of fat and fatty acids in the intestinal and mesenteric lymphatic tissues. Bull Johns Hopkins Hosp. 1907;18:382–391
  2. Dutly F, Altwegg M. Whipple's disease and “Tropheryma whippelii.”. Clin Microbiol Rev. 2001;14:561–583
  3. Bai JC, Mazure RM, Vazques H, et al. Whipple's disease. Clin Gastroenterol Hepatol. 2004;2:849–860
  4. Marth T. Whipple's disease. In:  Mandell GL,  Bennett JE,  Dolin R editor. Principles and practice of infectious disease. New York, NY: Churchill Livingstone; 2005;p. 1306–1310
  5. Fenollar F, Puéchal X, Raoult D. Whipple's disease. N Engl J Med. 2007;356:55–66
  6. Schneider T, Moos V, Loddenkemper C, et al. Whipple's disease: new aspects of pathogenesis and treatment. Lancet Infect Dis. 2008;8:179–190
  7. Gerard A, Sarrot-Reynauld F, Liozon E, et al. Neurologic presentation of Whipple's disease: report of 12 cases and review of the literature. Medicine (Baltimore). 2002;81:443–457
  8. Mar′n M, Muñoz P, Sánchez M, et al. grupo de apoyo al manejo de la endocarditis infecciosa del hospital Gregorio Marañón, Madrid Tropheryma whipplei infective endocarditis as the only manifestation of Whipple's disease. J Clin Microbiol. 2007;45:2078–2081
  9. Relman DA, Schmidt TM, MacDermott RP, et al. Identification of the uncultured bacillus of Whipple's disease. N Engl J Med. 1992;327:293–301
  10. Raoult D, Birg ML, La Scola B, et al. Cultivation of the bacillus of Whipple's disease. N Engl J Med. 2000;342:620–625
  11. Maiwald M, von Herbay A, Fredericks DN, et al. Cultivation of Tropheryma whipplei from cerebrospinal fluid. J Infect Dis. 2003;188:801–808
  12. Bentley SD, Maiwald M, Murphy LD, et al. Sequencing and analysis of the genome of the Whipple's disease bacterium Tropheryma whipplei. Lancet. 2003;361:637–644
  13. Raoult D, Ogata H, Audic S, et al. Tropheryma whipplei twist: a human pathogenic actinobacteria with a reduced genome. Genome Res. 2003;13:1800–1809
  14. Paulley JW. A case of Whipple's disease (intestinal lipodystrophy). Gastroenterology. 1952;22:128–133
  15. Keinath RD, Merrell E, Vlietstra R, et al. Antibiotic treatment and relapse in Whipple's disease (Long term follow-up of 88 patients). Gastroenterology. 1985;88:1867–1873
  16. Cannon WR. Whipple's disease, genomics, and drug therapy. Lancet. 2003;361:1916
  17. Feurle GE, Marth T. An evaluation of antimicrobial treatment for Whipple's disease. Dig Dis Sci. 1994;39:1642–1648
  18. Vital Durand V, Lecomte C, Cathébras P, et al. Whipple's disease: clinical review of 52 cases. Medicine (Baltimore). 1997;76:170–184
  19. Fleming JL, Wiesner RH, Shorter RG. Whipple's disease: clinical, biochemical, and histopathological features and assessment of treatment in 29 patients. Mayo Clin Proc. 1988;63:539–551
  20. von Herbay , Otto HF. Whipple's disease: a report of 22 patients. Klin Wochenschr. 1988;66:533–539
  21. Maizel H, Ruffin JM, Dobbins WO. Whipple's disease: a review of 19 patients from one hospital and a review of the literature since 1950. Medicine (Baltimore). 1970;49:175–205
  22. Bai JC, Crosetti EE, Mauriño EC, et al. Short-term antibiotic treatment in Whipple's disease. J Clin Gastroenterol. 1991;13:303–307
  23. Geboes K, Ectors N, Heidbuchel H, et al. Whipple's disease: the value of upper gastrointestinal endoscopy for the diagnosis and follow-up. Acta Gastroenterol Belg. 1992;55:209–219
  24. Feurle GE, Volk B, Waldherr R. Cerebral Whipple's disease with negative jejunal histology. N Engl J Med. 1979;300:907–908
  25. Maiwald M, Ditton HJ, von Herbay A, et al. Reassessment of the phylogenetic position of the bacterium associated with Whipple's disease and determination of the 16S-23S ribosomal intergenic spacer sequence. Int Syst Bacteriol. 1996;46:1078–1082
  26. Sande MA, Mandell GL. Antimicrobial agents, tetracyclines, chloramphenicol, erythromycin, and miscellaneous antibacterial agents. In:  Goodman GA,  Goodman LS,  Rall TW, et al. editor. The pharmacological basis of therapeutics. Toronto, Ontario: Macmillan; 1985;p. 1170–1198
  27. von Herbay A, Ditton HJ, Schuhmacher F, et al. Whipple's disease: staging and monitoring by cytology and polymerase chain reaction analysis of cerebrospinal fluid. Gastroenterology. 1997;113:434–441
  28. von Herbay A, Maiwald M, Ditton HJ, et al. Histology of intestinal Whipple's disease revisited (A study of 48 patients). Virchows Arch. 1996;429:335–343
  29. Dreier J, Szabados F, von Herbay A, et al. Tropheryma whipplei infection of an acellular porcine heart valve bioprosthesis in a patient who did not have intestinal Whipple's disease. J Clin Microbiol. 2004;42:4487–4493
  30. von Herbay A, Ditton HJ, Maiwald M. Diagnostic application of a polymerase chain reaction assay for the Whipple's disease bacterium to intestinal biopsies. Gastroenterology. 1996;110:1735–1743
  31. Schöniger-Hekele M, Petermann D, Weber B, et al. Tropheryma whipplei in the environment: survey of sewage plant influxes and sewage plant workers. Appl Environ Microbiol. 2007;73:2033–2035
  32. Boulos A, Rolain JM, Raoult D. Antibiotic susceptibility of Tropheryma whipplei in MRC5 cells. Antimicrob Agents Chemother. 2004;48:747–752
  33. Boulos A, Rolain JM, Mallet MN, et al. Molecular evaluation of antibiotic susceptibility of Tropheryma whipplei in axenic medium. J Antimicrob Chemother. 2005;55:178–181
  34. Wang EEL, Prober CG. Ventricular cerebrospinal fluid concentrations of trimethoprim-sulphamethoxazole. J Antimicrob Chemother. 1983;11:385–389
  35. Spector R. Ceftriaxone pharmacokinetics in the central nervous system. J Pharmacol Exp Ther. 1986;236:380–383
  36. Dagan R, Velghe L, Rodda JL, et al. Penetration of meropenem into the cerebrospinal fluid of patients with inflamed meninges. J Antimicrob Chem. 1994;34:175–179
  37. Schmutzhard E, Williams KJ, Vukmirovits G, et al. A randomised comparison of meropenem with cefotaxime or ceftriaxone for the treatment of bacterial meningitis in adults. J Antimicrob Chemother. 1995;36(Suppl A):85–97
  38. Fenollar F, Trani M, Davoust B, et al. Prevalence of asymptomatic Tropheryma whipplei carriage among humans and nonhuman primates. J Infect Dis. 2008;197:880–887

 This article has an accompanying continuing medical education activity on page e11. Learning Objective: Upon completion of reading this article, successful learners will be able to define the primary diagnostic procedures to diagnose Whipple's disease and will to be able to specify the circumstances in a puzzling illness in which it is not necessary to consider Whipple's disease. The learner should further be able to select the most appropriate procedure to diagnose cerebral Whipple's disease and to define to-days evidence-based strategy in the treatment of Whipple's disease.

 Conflicts of interest The authors disclose no conflicts.

 Funding This work was supported by the Fifth Framework Program of the European Union (QLG1-CT-2002-01049). Dr Feurle was supported by the European Commission and has received an honorarium for a written expert opinion from Roche Pharma AG, Grenzach–Wyhlen, the producer of Ceftriaxone. Roche has never been in contact with Dr Feurle concerning the randomized trial. Drs Junga and Marth have received support from the European Commission.

PII: S0016-5085(09)01938-6

doi: 10.1053/j.gastro.2009.10.041

Gastroenterology
Volume 138, Issue 2 , Pages 478-486 , February 2010

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