%0 Journal Article
%T Progressive dementia associated with ataxia or obesity in patients with Tropheryma whipplei encephalitis
%A Florence Fenollar
%A Fran£żois Nicoli
%A Claire Paquet
%A Hubert Lepidi
%A Patrick Cozzone
%A Jean-Christophe Antoine
%A Jean Pouget
%A Didier Raoult
%J BMC Infectious Diseases
%D 2011
%I BioMed Central
%R 10.1186/1471-2334-11-171
%X We first diagnosed a patient presenting dementia and obesity whose brain biopsy and cerebrospinal fluid specimens contained T. whipplei DNA and who responded dramatically to antibiotic treatment. We subsequently tested cerebrospinal fluid specimens and brain biopsies sent to our laboratory using T. whipplei PCR assays. PAS-staining and T. whipplei immunohistochemistry were also performed on brain biopsies. Analysis was conducted for 824 cerebrospinal fluid specimens and 16 brain biopsies.We diagnosed seven patients with T. whipplei encephalitis who demonstrated no digestive involvement. Detailed clinical histories were available for 5 of them. Regular PCR that targeted a monocopy sequence, PAS-staining and immunohistochemistry were negative; however, several highly sensitive and specific PCR assays targeting a repeated sequence were positive. Cognitive impairments and ataxia were the most common neurologic manifestations. Weight gain was paradoxically observed for 2 patients. The patients' responses to the antibiotic treatment were dramatic and included weight loss in the obese patients.We describe a new clinical condition in patients with dementia and obesity or ataxia linked to T. whipplei that may be cured with antibiotics.Whipple's disease is a paradigm of the evolution of infectious disease knowledge [1]. The disease was first described in 1907 by Whipple [2], who based it on anatomopathological lesions identified in a patient at autopsy. For many years, it was considered to be a metabolic disorder; however, in 1952, a bacterial origin became suspected when antibiotic treatment proved effective [3]. The first molecular identification of the bacterium associated with Whipple's disease (Tropheryma whipplei), as well as the first culture, created a new field [4,5]. T. whipplei has been identified in the saliva and stool specimens of healthy people [1]. The well-known and classic form of Whipple's disease, which is characterised by periodic acid-Schiff (PAS)-staine
%U http://www.biomedcentral.com/1471-2334/11/171