localized chronic infections that can occur with T whipplei infection
T. whipplei can cause localized infections that are not manifested as the classic, multisystem, form of Whipple’s disease. Stool and saliva samples may often be negative by PCR and/or PAS-stained duodenal biopsy.
- • Endocarditis: In this form of endocarditis, the bacterium is an intracellular infection rather than biofilm colonization. Clinical signs are similar to those of patients with culture-negative endocarditis of other etiologies. Many (79%) of the patients with diagnosed localized endocarditis due to T. whipplei displayed vegetations. When compared with cardiac valves from patients with endocarditis of other etiologies, those with endocarditis due to T. whipplei displayed more fibrosis, lack of calcification, slightly less vegetations, reduced vascularization, and reduced inflammation.
- • Encephalitis: In cases of encephalitis due to T. whipplei but no evidence of classic Whipple’s disease, the most common symptoms reported are cognitive impairment, ataxia, and supranuclear ophthalmoplegia. Ataxia and dementia have been shown to be more severe in patients with encephalitis than in those with classic Whipple’s disease.