Whipple's endocarditis: Review of the literature and comparisons with Q fever, Bartonella infection, and blood culture-positive endocarditis

Whipple's disease is a systemic infection sometimes associated with cardiac manifestations. Recently, there has been an increase in the number of repo rted cases of Whipple's endocarditis. The purpose of our study was to descr ibe this entity. Data from 35 well-described cases of Whipple's endocarditi s were collected and compared with those of blood culture-positive endocard itis, Q fever endocarditis, and Bartonella endocarditis. Some patients with generalized Whipple's disease presented with cardiac involvement, among ot her symptoms. Others presented with a nonspecific, blood culture-negative e ndocarditis with no associated symptoms. In comparison with cases of endoca rditis due to other causes, congestive heart failure, fever, and previous v alvular disease were less frequently observed in the cases of Whipple's end ocarditis. Without examination of the excised valves, the diagnosis of infe ctive endocarditis could not have been confirmed in most cases. Treatment i s not well established. Whipple's endocarditis is a specific entity involvi ng minor inflammatory reactions and negative blood cultures, and its incide nce is probably underestimated.