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Médecine thérapeutique / Pédiatrie

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Tropheryma whipplei in childhood Volume 15, issue 2, Avril-Mai-Juin 2012

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Authors
Université Aix-Marseille, faculté de médecine, URMITE, CNRS UMR 6236 IRD 198, IFR 48, 27, boulevard Jean-Moulin, 13385 Marseille Cedex 05, 75015 France, CHU Nord, service d’urgences pédiatriques, chemin des Bourrelly, 13915 Marseille Cedex 20, France, Institut national de la santé et de la recherche médicale, université Paris Descartes, faculté de médecine Necker, laboratoire de génétique humaine des maladies infectieuses, U980, Paris, 75015 France

Tropheryma whipplei is the bacterial infectious agent of Whipple's disease. The isolation of the first strain of T. whipplei has allowed the development of diagnostic tools, including molecular biology techniques that have been a capital contribution to a better characterization of the bacterium. The primo-infection appears probably in the childhood as acute infections (gastroenteritis, pneumopathy and/or bacteremia). Then, a cure is observed in most of the cases; a chronic carriage, mainly in stool specimens, is possible with a variable prevalence depending of geographical area. In rare cases, chronic infections will develop during adulthood among specific hosts. Among them, we observe the classic Whipple's disease characterized by a histological involvement and also localized chronic infection represented mainly by endocarditis, neurological involvement or uveitis. Strong beam of arguments suggests the existence of specific inherited immunodeficiencies associated with these chronic infections. Classic Whipple's disease requires antibiotic treatment in the long-term, but currently no specific treatment is available for carriage and acute infections, especially in children.