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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 RaoultComments to Author 
Author affiliations: Aix-Marseille Université, Marseille, France (F. Fenollar, J.-C. Lagier, H. Lepidi, P.-E. Fournier, D. Raoult); Assistance Publique Hopitaux de Marseille, Marseille (F. Fenollar, J.-C. Lagier, P.-E. Fournier, D. Raoult); Groupement Hospitalier Est, Bron, France (M. Célard)

Main Article

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.

Main Article

Page created: October 28, 2013
Page updated: October 28, 2013
Page reviewed: October 28, 2013
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