Characteristics of the immune response in a patient with Whipple's disease

A patient with Whipple's disease has been studied to examine the effect of antibiotic therapy on the immune status of the patient, and the specific immune response to a cell wall deficient form of an alpha-haemolytic streptococcus (alpha HS) isolated from this patient. T lymphocyte numbers were reduced, and cutaneous anergy was present. Autoantibodies directed against smooth muscle and mitochondria were detected. These abnormal parameters became normal following antibiotic therapy. The specific immune response to the alphaHS was characterised by IgA antibody and lymphocyte sensitisation. The latter was detected as antigen-inducedd lymphocyte stimulation and antigen-induced leucocyte inhibition factor (LIF) production. Antibiotic therapy was associated with a fall in antibody titre and reduced LIF production. No defect in neutrophil function was found. These results are most consistent with the postulates that (i) immunological abnormalities in Whipple's disease are secondary to infection and (ii) the primary abnormality is an unusual pathogenic bacterium.