Travel Medicine and Infectious Disease (2015) 13, 114

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Tropheryma whipplei as a causative agent of travelers’ diarrhea: Further studies required. Reply to Razavi SM

Dear Editor, We thank Professor Razavi for his comment [1] on our paper on the occurrence of Trophyrema whipplei during diarrhea in Hajj pilgrims [2]. T. whipplei as many bacteria and viruses including Salmonella sp., Clostridium difficile and rotavirus for example, may be pathogenic or not when found in stools. The fact that T. whipplei was found in pilgrims with diarrhea during their stay in Saudi Arabia but not before is the strongest evidence of causality that can be provided. There are no false positives described with the techniques reported in this work since the validity of the data is based on strict experimental procedures and controls, including rigorous positive and negative controls to validate the test. In addition, each positive PCR result was confirmed by the successful amplification of an additional DNA sequence [3]. Strong evidence has suggested that T. whipplei causes mild gastroenteritis in children; associated with seropositivity and high bacterial loads in the stool followed by disappearance of T. whipplei DNA in stool samples in these children when recovering from diarrhea [4]. Healthy children are not infected with T. whipplei [4]. T. whipplei has been isolated and cultured [5]. Finally, an animal model was developed to support this hypothesis. It was demonstrated that orally given T. whipplei induced transcient diarrhea in mice, without any signs of intestinal tissue invasion and T. whipplei DNA was not detected in mouse stool samples after the diarrheal episode [6]. Together, these results fulfil Koch’s postulate for the causative role of T. whipplei as an agent of acute diarrhea.

Conflict of interest None.

DOI of original article: http://dx.doi.org/10.1016/ j.tmaid.2014.12.004. Abbreviations: EHI, Entamoeba histolytica infection. http://dx.doi.org/10.1016/j.tmaid.2015.01.001 1477-8939/ª 2015 Elsevier Ltd. All rights reserved.

References [1] Razavi SA. Tropheryma whipplei as a causative agent of traveler’s diarrhea: further studies required. Travel Med Infect Dis 2015;13:112e3. [2] Gautret P, Benkouiten S, Parola P, Brouqui P, Memish Z, Raoult D. Occurrence of Tropheryma whipplei during diarrhea in Hajj pilgrims: a PCR analysis of paired rectal swabs. Travel Med Infect Dis 2014;12:481e4. [3] Fenollar F, Laouira S, Lepidi H, Rolain JM, Raoult D. Value of Tropheryma whipplei quantitative polymerase chain reaction assay for the diagnosis of Whipple disease: usefulness of saliva and stool specimens for first-line screening. Clin Infect Dis 2008;47:659e67. [4] Raoult D, Fenollar F, Rolain JM, Minodier P, Bosdure E, Li W, et al. Tropheryma whipplei in children with gastroenteritis. Emerg Infect Dis 2010;16:776e82. [5] Raoult D, Birg ML, La Scola B, Fournier PE, Enea M, Lepidi H, et al. Cultivation of the bacillus of Whipple’s disease. N Engl J Med 2000;342:620e5. [6] Al Moussawi K, Malou N, Mege JL, Raoult D, Desnues B. An experimental mouse model to establish Tropheryma whipplei as a diarrheal agent. J Infect Dis 2011;204:44e50.

Philippe Gautret* Didier Raoult Assistance Publique Hoˆpitaux de Marseille, CHU Nord, Poˆle Infectieux, Institut Hospitalo-Universitaire Me´diterrane´e Infection, 13015 Marseille, France Aix Marseille Universite´, Unite´ de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, Faculte´ de Me´decine, 27 bd Jean Moulin, 13005 Marseille, France *Corresponding author. Assistance Publique Ho ˆpitaux de Marseille, CHU Nord, Po ˆle Infectieux, Institut HospitaloUniversitaire Me ´diterrane ´e Infection, 13015 Marseille, France. E-mail address: [email protected] (P. Gautret) 5 January 2015 Available online 13 January 2015

Tropheryma whipplei as a causative agent of travelers' diarrhea: further studies required. Reply to Razavi SM.

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