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25029 Tropheryma whipplei, PCR (TWRP)

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

​Ref Lab Code: 80909, Whipple's Disease

Useful For
As an aid in diagnosis of Whipple disease, especially for identifying inconclusive or suspicious cases​
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:​

Biopsy

Preferred: Small intestine tissue (duodenum, ileum, or jejunum)

Acceptable: Tissue or biopsy specimen of brain, gastrointestinal tissue, heart valve, lymph node, small intestine, synovial tissue, or other visceral tissue fixed in a paraffin block

 Sterile container ​ ​Entire collection 5 mm​ ​
​Spinal, synovial, or vitreous humor fluid ​Sterile vial ​ ​0.5 mL ​0.5 mL ​
Collection Processing Instructions
Biopsy: Collect fresh tissue specimen.
 
Specimens grossly contaminated with blood may inhibit the PCR and produce false-negative results.
 
The high sensitivity of amplification by PCR requires the specimen to be processed in an environment in which contamination of the specimen by Tropheryma whipplei DNA is not likely.
Specimen Stability Information
Specimen Type Temperature Time
Biopsy​ ​Frozen (preferred) ​< 48 hours
​ ​Refrigerated ​< 48 hours
​Spinal, synovial, or vitreous humor fluid ​Refrigerated (preferred) ​< 48 hours
​ ​Frozen ​< 48 hours
Rejection Criteria
Heparin Green Top Tube (GTT)
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Mayo Medical Laboratories Monday, Wednesday, Friday​ ​2 days
Rapid Polymerase Chain Reaction (PCR)
(PCR is utilized pursuant to a license agreement with Roche Molecular Systems, Inc.)​
Reference Lab
Mayo Clinic Laboratories
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.
Reference Range Information
Performing Location Reference Range
​Mayo Medical Laboratories ​Negative
Interpretation
A positive result strongly suggests a diagnosis of Whipple disease.
 
A negative result does not negate the presence of the organism or active disease, as false negative results may occur due to inhibition of PCR, sequence variability underlying the primers and/or probes or the presence of Tropheryma whipplei in quantities less than the limit of detection of the assay.
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​87798 ​ ​ ​ ​
Synonyms/Keywords

​Ref Lab Code: 80909, 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:​

Biopsy

Preferred: Small intestine tissue (duodenum, ileum, or jejunum)

Acceptable: Tissue or biopsy specimen of brain, gastrointestinal tissue, heart valve, lymph node, small intestine, synovial tissue, or other visceral tissue fixed in a paraffin block

 Sterile container ​ ​Entire collection 5 mm​ ​
​Spinal, synovial, or vitreous humor fluid ​Sterile vial ​ ​0.5 mL ​0.5 mL ​
Collection Processing
Biopsy: Collect fresh tissue specimen.
 
Specimens grossly contaminated with blood may inhibit the PCR and produce false-negative results.
 
The high sensitivity of amplification by PCR requires the specimen to be processed in an environment in which contamination of the specimen by Tropheryma whipplei DNA is not likely.
Specimen Stability Information
Specimen Type Temperature Time
Biopsy​ ​Frozen (preferred) ​< 48 hours
​ ​Refrigerated ​< 48 hours
​Spinal, synovial, or vitreous humor fluid ​Refrigerated (preferred) ​< 48 hours
​ ​Frozen ​< 48 hours
Rejection Criteria
Heparin Green Top Tube (GTT)
Useful For
As an aid in diagnosis of Whipple disease, especially for identifying inconclusive or suspicious cases​
Reference Range Information
Performing Location Reference Range
​Mayo Medical Laboratories ​Negative
Interpretation
A positive result strongly suggests a diagnosis of Whipple disease.
 
A negative result does not negate the presence of the organism or active disease, as false negative results may occur due to inhibition of PCR, sequence variability underlying the primers and/or probes or the presence of Tropheryma whipplei 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 Medical Laboratories Monday, Wednesday, Friday​ ​2 days
Rapid Polymerase Chain Reaction (PCR)
(PCR is utilized pursuant to a license agreement with Roche Molecular Systems, Inc.)​
Reference Lab
Mayo Clinic Laboratories
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.