Tropheryma whippelii as a cause of afebrile culture-negative endocarditis:: the evolving spectrum of Whipple's disease

With the advent of molecular diagnostics culture-negative endocarditis caused by the organism Tropheryma whippelii is an increasingly described entity. We describe two patients with afebrile, culture-negative endocarditis caused by T. whippelii who had neither the gastrointestinal nor arthritic manifestations of Whipple's disease. Whipple's disease is a systemic illness caused by the organism Tropheryma whippelii and is typically characterized by diarrhea, weight loss, and arthropathy [Clin. Microbial. Rev. 2001; 14:561 - 583; Medicine (Baltimore) 1997; 76:170-184]. Whipple's endocarditis is relatively common in autopsy studies [Can. J. Cardiol. 1996; 12:831 834] but has rarely been diagnosed before death. With the advent of molecular diagnostic tools such as the polymerase chain reaction (PCR), Tropheryma whippelii as a cause of culture-negative endocarditis has become increasingly recognized [Clin. Infect. Dis. 2001; 33:1309-1316; Ann. Intern. Med. 1999; 131:112 - 116; Infection 2001;29:44-47; Ann. Intern. Med. 2000;132:595]. With this increased recognition has come the realization that Whipple's endocarditis can occur without other common manifestations of Whipple's disease [Ann. Intern. Med. 1999;131:112-116; infection 2001;29:44-47; Ann. Intern. Med. 2000;132:595]. We report here two cases of Whipple's endocarditis without discrete febrile illness, gastrointestinal manifestations, or arthritic manifestations, diagnosed by PCR of resected valvular material. (C) 2003 The British Infection Society. Published by Elsevier Science Ltd. All rights reserved.