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25029 Tropheryma whipplei, PCR (TWRP)

Tropheryma whipplei, PCR (TWRP)
Test Code: WHIPPSO
Synonyms/Keywords

​Whipple's Disease

Useful For
As an aid in diagnosis of Whipple disease, especially for identifying inconclusive or suspicious cases, using tissue or fluid specimens​
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
Submit only 1 of the following specimens:

Fresh tissue or Biopsy collected from:

Small intestine tissue (duodenum, ileum, or jejunum), lymph node, bone, joint, synovial, liver, pancreas, spleen, lung, heart valve (and other heart tissues), or brain

Sterile container ​Entire collection 5 mm​ (approximately the size of a pencil eraser)
Fluid:  Cerebrospinal or ocular (eg, vitreous humor) ​Sterile vial ​0.5 mL ​0.5 mL
​Synovial FluidEDTA ​Lavender Top Tube (LTT)​Pink Top Tube (PTT), Royal Blue Top EDTA Tube (RBTT), Sterile vial containing and EDTA-derived aliquot, red clot tube (no anticoagulant), or sterile container​0.5 mL​0.5 mL

​Paraffin-embedded Tissue Block prepared from:

Small intestine (duodenum, ileum or jejunum), lymph node, bone, joint, synovial, liver, pancreas, spleen, lung, heart valve (and other heart tissues) or brain

​Submit a FFPE tissue block to be cut and returned​Perform microtomy and prepare five separate 10-micron sections.  Each section (scroll) must be placed in a separate sterile container for submission. 
Collection Processing Instructions
Fresh tissue or biopsy:
1. Collect fresh tissue specimen.
2. Submit tissue only, do not add fluid to tissue.
3. Refrigerate or freeze specimen.
 
Synovial Fluid: 
Send specimen in original tube (preferred).
Specimen Stability Information
Specimen Type Temperature Time
Fresh Tissue or Biopsy​ ​ ​Refrigerated (preferred) ​< 7 days
Frozen ​< 7 days
​Cerebrospinal, Ocular or Synovial Fluid ​ ​Refrigerated (preferred) ​< 7 days
​Frozen ​< 7 days
​FFPE ​​Ambient (preferred)
​Refrigerated
Rejection Criteria
Slides, Bone Marrow
Interference

​Test results should be used as an aid in diagnosis and not be considered diagnostic in themselves. The single assay should not be used as the only criteria to form a clinical conclusion, but results should be correlated with patient symptoms and clinical presentation. A negative result does not negate the presence of the organism or active disease.

Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Mayo Clinic Laboratories Monday, Wednesday, Friday​ ​2 days Real-Time Polymerase Chain Reaction (PCR)
Reference Lab
Test Information
Whipple disease is a chronic, systemic illness that in the majority of cases involves the small intestine and its lymphatic drainage. The disease primarily affects middle-aged individuals, with a peak incidence in the third and fourth decades. Clinical findings may include malabsorption, chronic diarrhea, abdominal pain, arthralgia, fever, and central nervous system symptoms.
 
Pathologic changes associated with Whipple disease are distinctive, with diagnosis dependent on histologic examination of biopsy specimens from involved tissues. Electron microscopic or special high-resolution light microscopic examination of the lamina propria of the small intestine of patients with untreated Whipple disease reveals many rod-shaped bacillary organisms. These tiny bacilli, referred to as Whipple bacilli, measure about 0.25 micrometer long and are seen as periodic acid-Schiff-positive granules within macrophages. These inclusions represent fragments of the cell walls from degenerating bacilli.
 
Culture of Whipple bacilli from biopsy material is laborious and the organism is very slow growing. Definitive identification of the Whipple associated bacillus has been difficult because of these limitations. Recently, molecular techniques using PCR and nucleotide sequencing allowed classification of this bacillus as an actinomycete not closely related to any other known species, which has been named Tropheryma whipplei.
Interpretation
A positive result indicates the presence of Tropheryma whipplei DNA.
 
A negative result indicates the absence of detectable T whipplei DNA, does not negate the presence of the organism and may occur due to inhibition of PCR, sequence variability underlying primers or probes, or the presence of Tropheryma whipplei DNA in quantities less than the limit of detection of the assay.
Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
​87798
Synonyms/Keywords

​Whipple's Disease

Ordering Applications
Ordering Application Description
​Centricity ​Tropheryma whipplei, PCR (TWRP)
​Cerner ​Tropheyma whipplei, PCR (80909)
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
Submit only 1 of the following specimens:

Fresh tissue or Biopsy collected from:

Small intestine tissue (duodenum, ileum, or jejunum), lymph node, bone, joint, synovial, liver, pancreas, spleen, lung, heart valve (and other heart tissues), or brain

Sterile container ​Entire collection 5 mm​ (approximately the size of a pencil eraser)
Fluid:  Cerebrospinal or ocular (eg, vitreous humor) ​Sterile vial ​0.5 mL ​0.5 mL
​Synovial FluidEDTA ​Lavender Top Tube (LTT)​Pink Top Tube (PTT), Royal Blue Top EDTA Tube (RBTT), Sterile vial containing and EDTA-derived aliquot, red clot tube (no anticoagulant), or sterile container​0.5 mL​0.5 mL

​Paraffin-embedded Tissue Block prepared from:

Small intestine (duodenum, ileum or jejunum), lymph node, bone, joint, synovial, liver, pancreas, spleen, lung, heart valve (and other heart tissues) or brain

​Submit a FFPE tissue block to be cut and returned​Perform microtomy and prepare five separate 10-micron sections.  Each section (scroll) must be placed in a separate sterile container for submission. 
Collection Processing
Fresh tissue or biopsy:
1. Collect fresh tissue specimen.
2. Submit tissue only, do not add fluid to tissue.
3. Refrigerate or freeze specimen.
 
Synovial Fluid: 
Send specimen in original tube (preferred).
Specimen Stability Information
Specimen Type Temperature Time
Fresh Tissue or Biopsy​ ​ ​Refrigerated (preferred) ​< 7 days
Frozen ​< 7 days
​Cerebrospinal, Ocular or Synovial Fluid ​ ​Refrigerated (preferred) ​< 7 days
​Frozen ​< 7 days
​FFPE ​​Ambient (preferred)
​Refrigerated
Rejection Criteria
Slides, Bone Marrow
Interference

​Test results should be used as an aid in diagnosis and not be considered diagnostic in themselves. The single assay should not be used as the only criteria to form a clinical conclusion, but results should be correlated with patient symptoms and clinical presentation. A negative result does not negate the presence of the organism or active disease.

Useful For
As an aid in diagnosis of Whipple disease, especially for identifying inconclusive or suspicious cases, using tissue or fluid specimens​
Interpretation
A positive result indicates the presence of Tropheryma whipplei DNA.
 
A negative result indicates the absence of detectable T whipplei DNA, does not negate the presence of the organism and may occur due to inhibition of PCR, sequence variability underlying primers or probes, or the presence of Tropheryma whipplei DNA in quantities less than the limit of detection of the assay.
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Mayo Clinic Laboratories Monday, Wednesday, Friday​ ​2 days Real-Time Polymerase Chain Reaction (PCR)
Reference Lab
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
​87798
For most current information refer to the Marshfield Laboratory online reference manual.