@article{PAR00011277,
  title = {{T}reatment of classic {W}hipple's disease : from in vitro results to clinical outcome},
  author = {{L}agier, {J}. {C}. and {F}enollar, {F}. and {L}epidi, {H}. and {G}iorgi, {R}. and {M}illion, {M}. and {R}aoult, {D}idier},
  editor = {},
  language = {{ENG}},
  abstract = {{O}bjectives: {P}atients with classic {W}hipple's disease have a lifetime defect in immunity to {T}ropheryma whipplei and frequently develop treatment failures, relapses or reinfections. {E}mpirical treatments were tested before culture was possible, but the only in vitro bactericidal treatment consists of a combination of doxycycline and hydroxy-chloroquine. {M}ethods: {O}ur laboratory has been a reference centre since the first culturing of {T}ropheryma whipplei, and we have tested 27000 samples by {PCR} and diagnosed 250 cases of classic {W}hipple's disease. {W}e report here the clinical course of patients who were followed by one of our group. {R}esults: {O}f 29 patients, 22 (76%) were previously treated with immunosuppressive drugs, 26 (90%) suffered from arthralgias and 22 (76%) exhibited weight loss. {I}ntravenous initial treatment was paradoxically associated with an increased risk of failure ({P} = 0.0282). {T}reatment 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. {A}mong the patients treated with doxycycline and hydroxychloroquine after previous antibiotic treatments, two presented with a reinfection caused by different {T}. whipplei strains. {F}inally, 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. {C}onclusions: {I}n vitro results were confirmed by clinical outcomes and trimethoprim/sulfamethoxazole was associated with failures. {T}he 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.},
  keywords = {{T}ropheryma whipplei ; doxycycline ; lifetime prophylaxis ; antimicrobial ; therapy},
  booktitle = {},
  journal = {{J}ournal of {A}ntimicrobial {C}hemotherapy},
  volume = {69},
  numero = {1},
  pages = {219--227},
  ISSN = {0305-7453},
  year = {2014},
  DOI = {10.1093/jac/dkt310},
  URL = {https://www.documentation.ird.fr/hor/{PAR}00011277},
}