meropenem and Central-Nervous-System-Diseases

Whipple's disease is a multisystemic infection caused by the ubiquitous bacterium Tropheryma whipplei. Immunological host factors enable classical Whipple's disease; however, T. whipplei can be found in three other clinical conditions: healthy colonization, self-limiting infections, and isolated endocarditis. The genetic predisposition of the host rather than the genotype of the bacterium influences the infection. Modern diagnostic methods elucidate the many facets of Whipple's disease. In particular, isolated T. whipplei-induced infective endocarditis can only be diagnosed after valve resection. The sole treatment of Whipple's disease evaluated prospectively comprises intravenous induction therapy with ceftriaxone or meropenem, followed by continuation therapy with oral TMP-SMX. In the case of Immune reconstitution inflammatory syndrome (IRIS) or inflammatory lesions of the CNS in the setting of Whipple's disease, additional treatment with corticosteroids should be considered to avoid severe tissue damage.

Topics: Adrenal Cortex Hormones; Adult; Algorithms; Anti-Bacterial Agents; Biopsy; Carrier State; Ceftriaxone; Central Nervous System Diseases; Child; Diagnosis, Differential; Drug Therapy, Combination; Duodenum; Endocarditis, Bacterial; Gastroscopy; Genetic Predisposition to Disease; Heart Valves; Humans; Immune Reconstitution Inflammatory Syndrome; Meropenem; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Whipple Disease

Topics: Anti-Bacterial Agents; Ceftriaxone; Central Nervous System Diseases; Chloroquine; Drug Resistance, Bacterial; Drug Therapy, Combination; Humans; Male; Meropenem; Microbial Sensitivity Tests; Minocycline; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease