PCR analysis is superior to histology for diagnosis of Whipple's disease mimicking seronegative rheumatic diseases
| Autor: | Wolfgang Hartung, Boris Ehrenstein, C Dragonas, P Lehmann, Martin Fleck, Udo Reischl |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
0301 basic medicine
Adult Male Pathology medicine.medical_specialty 030106 microbiology Immunology Periodic acid–Schiff stain Polymerase Chain Reaction law.invention Tropheryma whipplei Diagnosis Differential 03 medical and health sciences 0302 clinical medicine Rheumatology law Rheumatic Diseases Immunology and Allergy Medicine Humans Whipple's disease Polymerase chain reaction Aged Retrospective Studies biology business.industry Whipple Disease Retrospective cohort study Histology General Medicine Middle Aged biology.organism_classification medicine.disease Anti-Bacterial Agents 030211 gastroenterology & hepatology Female Differential diagnosis business |
| Zdroj: | Scandinavian journal of rheumatology. 46(2) |
| ISSN: | 1502-7732 |
| Popis: | The diagnosis of Whipple's disease (WD) is commonly confirmed by histology demonstrating Periodic Acid Schiff (PAS)-positive macrophages in the duodenal mucosa. Analysis of intestinal tissue or other specimens using polymerase chain reaction (PCR) is a more sensitive method. However, the relevance of positive PCR findings is still controversial. Therefore, we evaluated the relevance of histology and PCR findings to establishing the diagnosis of WD in a series of WD patients initially presenting with suspected rheumatic diseases.Between 2006 and 2014, 20 patients with seronegative rheumatic diseases tested positive for Tropheryma whipplei (Tw) by PCR and/or histology and were enrolled in a retrospective analysis of the diagnostic value of both procedures.Seven of the 20 cases (35%) were diagnosed with 'classic' WD as indicated by PAS-positive macrophages. In the remaining 13 patients, the presence of Tw was detected by intestinal (n = 10) or synovial PCR analysis (n = 3). Two of the 20 patients (10%) with evidence of Tw did not respond to antibiotic therapy. They were not considered to suffer from WD. Therefore, relying only on histological findings of intestinal biopsies would have missed 11 (61%) of the 18 patients with WD in our cohort. In comparison, PCR of intestinal biopsies detected Tw-DNA in 14 (93%) of the 15 WD patients evaluated. Patients with a positive histology did not differ from PCR-positive patients with regard to sex, age, or duration of disease, but more often presented with gastrointestinal symptoms.A substantial number of WD patients present without typical intestinal histology findings. Additional PCR analysis of intestinal tissue or synovial fluid increased the sensitivity of the diagnostic evaluation and should be considered particularly in patients presenting with atypical seronegative rheumatic diseases and a high-risk profile for WD. |
| Databáze: | OpenAIRE |
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