Microbiology · Other clinically important bacteria
Tropheryma whipplei !
- Bacterium
- Gram-positive
- For completeness
A rare bacterium that causes Whipple disease: joint pain, diarrhoea with malabsorption and weight loss; untreated, it is fatal.
Updated 2026-11-01
At a glance
- Gram
- Gram-positive
- Shape
- Rod
- Family
- Actinomycetes (Tropherymataceae)
- Stain
- PAS-positive macrophages on small-bowel biopsy
Morphology
- Gram-positive rod of the actinomycete group
- Very hard to culture in the laboratory
- Accumulates inside macrophages of the intestinal mucosa
Transmission
- Probably faecal-oral from the environment; many people carry it without illness
- Disease depends on a subtle defect in host immunity
Reservoir: Environment (soil, sewage) and healthy human carriers
Isolation precautions
What the care team adds to standard precautions.
- Standard
Virulence factors
- Survives inside macrophages, which fail to kill it
- Laden macrophages fill the villi and block lymphatics: malabsorption
- Invades many organs: joints, heart, nervous system and lymph nodes
Diseases it causes
- Whipple disease Whipple disease →
- Culture-negative endocarditis Infective endocarditis →
Clinical picture
- Arthralgia or migratory arthritis, often years before the gut symptoms
- Diarrhoea, steatorrhoea, abdominal pain and weight loss
- Fever, lymphadenopathy and skin hyperpigmentation
- Neurological involvement: memory changes and abnormal eye movements
Diagnosis
- Endoscopic small-bowel biopsy: macrophages with PAS-positive inclusions
- PCR for T. whipplei in tissue or other fluids
- Malabsorption labs: low albumin and fat in stool
Treatment
Prolonged antibiotic treatment: intravenous ceftriaxone first, then oral trimethoprim-sulfamethoxazole for a long time; an alternative is doxycycline with hydroxychloroquine. Relapses are possible, including in the nervous system.
Drug class only; doses and regimens are set by the clinician from the current guideline.
In Pharmacology:
Prevention
- No specific prevention
- Long follow-up to detect relapse
Test yourself
Think of the answer, then tap the question to see it.
Which small-bowel biopsy finding suggests Whipple disease?
Macrophages packed with PAS-positive inclusions in the lamina propria.
What is usually the first symptom of Whipple disease?
Joint pain or arthritis, which can come years before diarrhoea and weight loss.
Which kind of endocarditis can Tropheryma whipplei cause?
Culture-negative endocarditis.
What happens if Whipple disease is not treated?
It is usually fatal; with prolonged antibiotics most patients improve, although it can relapse.
Related
Related conditions
← Back to the group: Other clinically important bacteria
Educational content on microorganisms; not a treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Whipple disease: MedlinePlus Medical Encyclopedia (MedlinePlus (NLM), 2024); Whipple Disease - Symptoms, Causes, Treatment | NORD (National Organization for Rare Disorders (NORD), 2024).
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Representative model, for educational purposes only.