A 21st Century Appraisal of Whipple’s Disease and Tropheryma whipplei

Whipple’s disease was formally described more than 100 years ago; nonetheless, only recently have investigators identified, cultivated, and characterized the causative agent, Tropheryma whipplei, and deciphered some of its complex associations with human hosts. The acquisition of knowledge about T. whipplei, a Gram-positive bacterium in the class Actinobacteria, accelerated at an extraordinarily rapid pace during the first two decades of the 21st century, to include the recognition of asymptomatic carriage, localized disease, and acute infections caused by this peculiar bacterium. This review discusses current knowledge of the microbiology and epidemiology of T. whipplei, the expanding clinical spectrum of disease caused by the pathogen, its treatment, and historical and diagnostic assays that facilitate the diagnosis of the various diseases caused by this enigmatic bacterium. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.