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Lagier J. C., Fenollar F., Lepidi H., Giorgi R., Million M., Raoult Didier. (2014). Treatment of classic Whipple's disease : from in vitro results to clinical outcome. Journal of Antimicrobial Chemotherapy, 69 (1), p. 219-227. ISSN 0305-7453.

Titre du document
Treatment of classic Whipple's disease : from in vitro results to clinical outcome
Année de publication
2014
Type de document
Article référencé dans le Web of Science WOS:000328425400032
Auteurs
Lagier J. C., Fenollar F., Lepidi H., Giorgi R., Million M., Raoult Didier
Source
Journal of Antimicrobial Chemotherapy, 2014, 69 (1), p. 219-227 ISSN 0305-7453
Objectives: Patients with classic Whipple's disease have a lifetime defect in immunity to Tropheryma whipplei and frequently develop treatment failures, relapses or reinfections. Empirical treatments were tested before culture was possible, but the only in vitro bactericidal treatment consists of a combination of doxycycline and hydroxy-chloroquine. Methods: Our laboratory has been a reference centre since the first culturing of Tropheryma whipplei, and we have tested 27000 samples by PCR and diagnosed 250 cases of classic Whipple's disease. We report here the clinical course of patients who were followed by one of our group. Results: Of 29 patients, 22 (76%) were previously treated with immunosuppressive drugs, 26 (90%) suffered from arthralgias and 22 (76%) exhibited weight loss. Intravenous initial treatment was paradoxically associated with an increased risk of failure (P = 0.0282). Treatment with doxycycline and hydroxychloroquine (+/- sulfadiazine or trimethoprim/sulfamethoxazole) was associated with a better outcome (0/13 failures), whereas all 14 patients who were first treated with trimethoprim/sulfamethoxazole and referred to us (P < 0.0001) experienced failure. Among the patients treated with doxycycline and hydroxychloroquine after previous antibiotic treatments, two presented with a reinfection caused by different T. whipplei strains. Finally, serum therapeutic drug monitoring allowed us to detect a lack of compliance in the only patient with failure among the 22 patients treated with lifetime doxycycline. Conclusions: In vitro results were confirmed by clinical outcomes and trimethoprim/sulfamethoxazole was associated with failures. The recommended management is a combination of doxycycline and hydroxychloroquine for 1 year, followed by doxycycline for the patient's lifetime along with stringent therapeutic drug monitoring.
Plan de classement
Santé : généralités [050] ; Entomologie médicale / Parasitologie / Virologie [052]
Identifiant IRD
PAR00011277
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