@article{PAR00012710,
  title = {{W}hipple's disease and {T}ropheryma whipplei infections in internal medicine. {W}hen thinking about it ? {H}ow to treat ?},
  author = {{L}agier, {J}. {C}. and {F}enollar, {F}. and {R}aoult, {D}idier},
  editor = {},
  language = {{ENG}},
  abstract = {{T}ropheryma whipplei culture and genome sequencing have, thanks to new tools, rationalized both diagnosis and treatment of {W}hipple's disease. {W}hipple's disease involves mainly {C}aucasian male, approximately 50-years-old, suffering from arthralgia, weight loss and diarrhea. {A} worsening of clinical manifestations after immunosuppressive therapy is frequently observed while antibiotics prescribed for another infection improves the clinical status. {C}linical manifestations may more rarely suggest lymphoma or sarcoidosis. {P}ositive {T}. whipplei performed on both saliva and stool samples are strongly suggestive of {W}hipple's disease. {T}he diagnosis is confirmed by positive periodic acid {S}chiff staining or immunohistochemistry performed on small-bowel biopsies. {L}ocalized chronic infections are defined by the absence of histological duodenal involvement. {E}ndocarditis mainly occurs in 60-years-old men with arthralgia, cardiac failure or embolic events. {E}ncephalitis causes mainly cognitive and psychiatric involvement, and sometimes dementia, ataxia and weight gain. {U}veitis and arthritis evolve chronically, and are frequently resistant to imrnunosuppressive treatment. {PCR} and culture (particularly for cerebrospinal fluid) performed on various tissues and fluids allow the localized infections diagnosis. {I}n classic {W}hipple's disease, the treatment with doxycycline (200 mg/day) and hydroxychloroquine (600 mg/day) for a length of 12 months followed by a lifetime treatment by doxycycline (200 mg/day) should be recommended to avoid reinfection. {I}n localized infections, a treatment with doxycycline (200 mg/day) and hydroxychloroquine (600 mg/day) is proposed for 12 to 18 months followed by a lifetime follow-up.},
  keywords = {{W}hipple's disease ; {T}rophelyma whipplei ; {G}astroenteritis ; {E}ndocarditis ; {E}ncephalitis ; {A}rthritis ; {U}veitis},
  booktitle = {},
  journal = {{R}evue de {M}edecine {I}nterne},
  volume = {35},
  numero = {12},
  pages = {801--807},
  ISSN = {0248-8663},
  year = {2014},
  DOI = {10.1016/j.revmed.2014.04.016},
  URL = {https://www.documentation.ird.fr/hor/{PAR}00012710},
}