Volume 19, Number 11—November 2013
CME ACTIVITY - Synopsis
Tropheryma whipplei Endocarditis
Florence Fenollar, Marie Célard, Jean-Christophe Lagier, Hubert Lepidi, Pierre-Edouard Fournier, and Didier Raoult
Table 2
Treatment, outcome, and follow-up data for 14 patients with Tropheryma whipplei endocarditis managed entirely by our team*
| Patient no.† | First drug (duration) | Second drug (duration)† | Outcome | Length of follow-up at the end of the last treatment |
|---|---|---|---|---|
| 1 |
AMX + GEN (15 d) |
DOX + HCQ (ongoing) |
Well, including arthralgia disappearance |
Ongoing treatment |
| 2 | AMX + GEN (15 d) | DOX + HCQ (ongoing) | Well, including arthralgia disappearance | Ongoing treatment |
| 5 | CEF + GEN (15 d) | DOX + HCQ (ongoing) | Well | Ongoing treatment |
| 6 | NA | DOX + HCQ (1 yr) | Well | 1 yr |
| 7 | AMX + GEN (NA) | DOX + HCQ (7 mo) | Relapse 4 mo after the end of treatment; prosthetic dehiscence without fever; heart valve positive by PAS and immunohistochemical staining; negative by PCR | Ongoing new treatment |
| 9 | AMC + GEN (11 d) | DOX + HCQ (ongoing) | Well | Ongoing treatment |
| 12 | CEF (5 d) | DOX + HCQ (ongoing) | Well | Ongoing treatment |
| 14 | CEF + GEN (15 d) | DOX + HCQ (1 yr) | Well | 2.5 yr |
| 17 | CEF + GEN (15 d) | DOX + HCQ (1.5 yr) | Well | 3.5 yr |
| 20 | NA | DOX + HCQ (1 yr) | Well | 6 mo |
| 21 | AMX + GEN (18 d) | SXT (1.5 yr) | Well | 5 yr |
| 23 | VAN + DOX + OFX (19 d) | DOX + HCQ (1.5 yr) | 1 yr after end of treatment, saliva sample positive for T. whipplei by PCR (genotype NA); SXT started and continued for 12 mo | 9 mo after onset of lifelong prophylaxis |
| 5.5 yr after end of treatment, saliva and fecal samples positive for T. whipplei by PCR (new genotype: 101); no cardiac abnormalities observed; started lifelong prophylaxis with DOX at 100 mg 2×/d; well | ||||
| 24 | AMX + GEN (4 wk) | DOX + HCQ (1.5 yr) | Well | 2 yr, then colon cancer and death |
| 25 | AMX + GEN (15 d) | SXT (14 mo) | 12 mo after the end of the treatment: saliva specimen positive for T. whipplei by PCR (genotype NA); SXT replaced DOX + HCQ after a perforated sigmoid diverticulitis with spreading peritonitis for 18 mo; well | 6 yr |
*Team from Assistance Publique Hôpitaux de Marseille, Marseille, France. All patients had undergone heart valve surgery. AMX, amoxicillin; GEN, gentamicin; HCQ,, hydroxychloroquine; PAS, periodic acid–Schiff; CEF, ceftriaxone ; AMC, amoxicillin–clavulanate; VAN, vancomycin; DOX, doxycycline; OFX, ofloxacin.
†DOX at 100 mg 2×/d and HCQ at 200 mg 3×/ d; SXT at 320 mg trimethoprim and 1,600 mg sulfamethoxazole 3×/d.
Page created: October 28, 2013
Page updated: October 28, 2013
Page reviewed: October 28, 2013
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