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HelpTest ID: TWRP Tropheryma whipplei, Molecular Detection, PCR, Varies
Reporting Name
Tropheryma whipplei PCRUseful For
Aiding in the diagnosis of Whipple disease, especially for identifying inconclusive or suspicious cases, using tissue or fluid specimens
Clinical Information
Whipple disease is a chronic, systemic illness that in the majority of cases involves the small intestine and its lymphatic drainage. The disease primarily affects middle-aged individuals, with a peak incidence in the third and fourth decades. Clinical findings may include malabsorption, chronic diarrhea, abdominal pain, arthralgia, fever, and central nervous system symptoms.
Pathologic changes associated with Whipple disease are distinctive, with diagnosis dependent on histologic examination of biopsy specimens from involved tissues. Electron microscopic or special high-resolution light microscopic examination of the lamina propria of the small intestine of patients with untreated Whipple disease reveals many rod-shaped bacillary organisms. These tiny bacilli, referred to as Whipple bacilli, measure about 0.25 micrometer long and are seen as periodic acid-Schiff-positive granules within macrophages. These inclusions represent fragments of the cell walls from degenerating bacilli.
Culture of Whipple bacilli from biopsy material is laborious and the organism is very slow growing. Definitive identification of the Whipple associated bacillus has been difficult because of these limitations. Recently, molecular techniques using PCR and nucleotide sequencing allowed classification of this bacillus as an actinomycete not closely related to any other known species, which has been named Tropheryma whipplei.
Interpretation
A positive result indicates the presence of Tropheryma whipplei DNA.
A negative result indicates the absence of detectable T whipplei DNA, but does not negate the presence of the organism and may occur due to inhibition of PCR, sequence variability underlying primers or probes, or the presence of T whipplei DNA in quantities less than the limit of detection of the assay.
Testing Algorithm
See Infective Endocarditis: Diagnostic Testing for Identification of Microbiological Etiology in Special Instructions.
Analytic Time
2 daysDay(s) and Time(s) Performed
Monday, Wednesday, Friday
Clinical Reference
1. Ramzan NN, Loftus E Jr, Burgart LJ, et al: Diagnosis and monitoring of Whipple disease by polymerase chain reaction. Ann Intern Med 1997;126:520-527
2. Morgenegg S, Dutly F, Altwegg M: Cloning and sequencing of a part of the heat shock protein 65 gene (hsp65) of "Tropheryma whippleii" and its use for detection of "T. whipplei" in clinical specimens by PCR. J Clin Microbiol 2000;38:2248-2253
3. von Herbay A, Ditton HJ, Schuhmacher F, et al: Whipple's disease: staging and monitoring by cytology and polymerase chain reaction analysis of cerebrospinal fluid. Gastroenterology 1997;113(2):434-441
4. Dolmans RA, Boel CH, Lacle MM, Kusters JG: Clinical manifestations, treatment, and diagnosis of Tropheryma whipplei infections. Clin Microbiol Rev. 2017 Apr;30(2):529-555. doi: 10.1128/CMR.00033-16
Method Name
Real-Time Polymerase Chain Reaction (PCR)
Specimen Type
VariesNecessary Information
Specimen source is required.
Specimen Required
The high sensitivity of amplification by PCR requires the specimen to be processed in an environment in which contamination of the specimen by Tropheryma whipplei DNA is unlikely.
Submit only 1 of the following specimens:
Specimen Type: Fresh tissue or biopsy
Sources: Small intestine tissue (duodenum, ileum, or jejunum), lymph node, other visceral tissue, synovial tissue, gastrointestinal tissue, heart valve, or brain
Container/Tube: Sterile container
Specimen Volume: Entire collection or 5 mm(3) - approximately the size of a pencil eraser
Collection Instructions:
1. Collect fresh tissue specimen.
2. Submit tissue only, do not add fluid to tissue
3. Refrigerate or freeze specimen.
Specimen Stability Information: Refrigerated (preferred) <7 days /Frozen <7 days
Preferred Paraffin-embedded tissue block:
Supplies: Tissue Block Container (T553)
Specimen Type: Formalin-fixed, paraffin-embedded tissue block (FFPE)
Sources: Small intestine tissue (duodenum, ileum, or jejunum), lymph node, other visceral tissue, synovial tissue, gastrointestinal tissue, heart valve, or brain
Container/Tube: Tissue block
Collection Instructions: Submit a formalin-fixed, paraffin-embedded tissue block to be cut and returned.
Specimen Stability Information: Ambient (preferred)/Refrigerated
Acceptable Paraffin-embedded tissue block:
Specimen Type: Formalin-fixed, paraffin-embedded tissue block (FFPE)
Sources: Small intestine tissue (duodenum, ileum, or jejunum), lymph node, other visceral tissue, synovial tissue, gastrointestinal tissue, heart valve, or brain
Container/Tube: Sterile container for each individual cut section (scroll).
Collection Instructions: Perform microtomy and prepare five separate 10-micron sections. Each section (scroll) must be placed in a separate sterile container for submission.
Specimen Stability Information: Ambient (preferred)/Refrigerated
Specimen Type: Fluid
Sources: Cerebrospinal or ocular (eg, vitreous humor)
Container/Tube: Sterile vial
Specimen Volume: 0.5 mL
Specimen Stability Information: Refrigerated (preferred) <7 days/Frozen <7 days
Specimen Type: Synovial fluid
Container/Tube:
Preferred: Lavender top (EDTA)
Acceptable: Pink top (EDTA), royal blue top (EDTA), sterile vial containing EDTA-derived aliquot, red clot tube (no anticoagulant), or sterile container
Specimen Volume: 0.5 mL
Collection Instructions: Send specimen in original tube (preferred).
Specimen Stability Information: Refrigerated (preferred) <7 days /Frozen <7 days
Specimen Minimum Volume
Fluid: 0.5 mL
Fresh tissue or biopsy: 5 mm(3)
Paraffin-embedded tissue block: two 10-micron sections
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Varies | Varies | ||
Special Instructions
Reference Values
Not applicable
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.CPT Code Information
87798
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| TWRP | Tropheryma whipplei PCR | In Process |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| SRC56 | Specimen source | 31208-2 |
| 22302 | Result | 42602-3 |
Forms
If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:
-Microbiology Test Request (T244)
mml-Behavioral, mml-Movement-Disorders, mml-CNS-Infections, mml-Pediatric