A serological assay using Tropheryma whipplei antigens for the presumptive exclusion of Whipple disease

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Liew, Kwee Chin
Nguyen, Chelsea
Waidyatillake, Nilakshi T
Nguyen, Trang
Walton, Aaron
Harris, Owen
Athan, Eugene
Stenos, John
Graves, Stephen R
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2023
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Abstract

Whipple disease (WD) is a rare infection in genetically susceptible people caused by the bacterium Tropheryma whipplei. An indirect immunofluorescence serological assay (IFA), detecting patient antibodies to the bacterium, was developed using T. whipplei as antigen. We hypothesised that this assay could be used to rule out WD in patients in whom the diagnosis was being considered, based on high immunoglobulin (Ig) G titres to T. whipplei. In this study, 16 confirmed WD patients and 156 age-matched controls from across Australia were compared serologically. WD patients mostly underproduced IgG antibody to T. whipplei, with titres of ≤1:32 being common. While at an antibody titre of <1:64 the assay sensitivity for WD was only 69% [95% confidence interval (CI) 41-89%], its specificity for excluding WD was 91% (95% CI 85-95%). This specificity increased to 95% (95% CI 90-98%) at an antibody titre of <1:16. Patients with antibody titres of >1:64 were unlikely to have WD. At this titre, the seroprevalence of T. whipplei IgG antibody was 92% (223/242) in Australian blood donors. Unlike other serological assays, which are used to confirm a specific infection, this novel assay is designed to rule out WD infection with a specificity in Australia of 91%. Further validation of this assay, by trialling in other countries, should now be undertaken, as its usefulness is dependent on there being a high background seropositivity to T. whipplei in the general population at the location in which the assay is being used.

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Pathology

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© 2023. This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/

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This publication has been entered in Griffith Research Online as an advance online version.

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Subject

Pathology (excl. oral pathology)

Gastroenterology and hepatology

Medical bacteriology

Microbiology

Clinical sciences

Oncology and carcinogenesis

Serological assay

Tropheryma whipplei

Whipple disease

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Liew, KC; Nguyen, C; Waidyatillake, NT; Nguyen, T; Walton, A; Harris, O; Athan, E; Stenos, J; Graves, SR, A serological assay using Tropheryma whipplei antigens for the presumptive exclusion of Whipple disease, Pathology, 2023

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