What is Whipple’s Disease

(Whipple’s disease; Intestinal lipodystrophy)

The Whipple’s disease is a severe disease, which is caused by the bacterium Tropheryma Whipple’s. Leading symptoms include arthritis, weight loss, abdominal pain, and diarrhea. The diagnosis is completed with a small bowel biopsy. Initial treatment consists of the administration of ceftriaxone or penicillin, followed by trimethoprim/sulfamethoxazole for at least one year.

When Whipple’s disease is a malabsorption syndrome. This typically means that nutrients cannot be absorbed through the intestines. It mainly affects white men aged between 30 and 60 years. Although he can manifest itself in many parts of the body (e.g., As heart, lung, brain, serous cavities, joints, eyes, GIT), the intestinal mucosa is getting infected. These patients may have minor defects in cell-mediated immunity that predispose them to infection with T. whippelii bacteria. Approximately 30% of patients carry the HLA-B27.

The Whipple’s disease is a severe disease, which is produced by the bacterium Tropheryma whippelii. Leading symptoms include arthritis, weight loss, abdominal pain, and diarrhea. The diagnosis is made with a small bowel biopsy. Initial treatment consists of the administration of ceftriaxone or penicillin, followed by trimethoprim/sulfamethoxazole for at least one year. When Whipple’s disease is a malabsorption syndrome. It mainly affects white men aged between 30 and 60 years. Although he can manifest itself in many parts of the body (e.g., As heart, lung, brain, serous cavities, joints, eyes, GIT), the intestinal mucosa is getting infected. These patients may have minor defects in cell-mediated immunity that predispose them to infection with T. whippelii.

Approximately 30% of patients carry the HLA-B27. Symptoms and signs The clinical manifestation is variable and depends on the affected organ system. The four primary symptoms of Whipple’s disease are arthralgia diarrhea abdominal pain weight loss As a rule, the first symptoms of arthritis and fever. Intestinal symptoms (eg., Aqueous diarrhea, steatorrhea, abdominal pain, anorexia, weight loss) are manifested mostly later, sometimes years after the first symptoms. It may be a visible or occult intestinal hemorrhage occur. Severe malabsorption may be in patients who are diagnosed with advanced disease. Other findings include growth in skin pigmentation,lymphadenopathy, anemia, chronic cough, serositis, peripheral edema, and CNS symptoms.

Diagnosis
Diagnostic endoscopy with small bowel biopsy One can overlook the diagnosis of Whipple’s disease in patients without prominent gastrointestinal symptoms. To a Whipple middle age should be considered among white men who have arthritis and abdominal pain, diarrhea, weight loss or other signs of malabsorption.` These patients receive an endoscopy of the upper gastrointestinal tract with the removal of a small bowel biopsy. The internal changes are specific and diagnostic. The most serious and typical of Whipple’s disease changes are made in the proximal small intestine. In light, microscopy can see PAS-positive macrophages that distort the villous architecture. Gram-positive, non-acid-fast bacteria (T. whippelii) can be detected in the lamina propria and in the macrophages. If T. Whipple is not visible, but Whipple’s disease is still clinically suspected, PCR assays and immunohistochemistry should be performed.

 

 

The Whipple’s disease is a severe disease, which is caused by the bacterium Tropheryma Whipple’s. Leading symptoms include arthritis, weight loss, abdominal pain, and diarrhea. The diagnosis is completed with a small bowel biopsy. Initial treatment consists of the administration of ceftriaxone or penicillin, followed by trimethoprim/sulfamethoxazole for at least one year.

The Whipple’s disease should be differentiated from the intestinal infection with Mycobacterium avium-intracellulare (MAI) having similar histological findings. However, in May are acid-resistant. Antibiotics later relapse possible. Untreated cases progressive and fatal. Some antibiotics affect curative (z. B. trimethoprim/sulfamethoxazole, chloramphenicol, ampicillin, penicillin, cephalosporins). Treatment of Whipple’s disease is with ceftriaxone (2 g iv daily) or penicillin G (1.5-6 million units iv every six h) initiated. In this regime, a long-term administration of trimethoprim/sulfamethoxazole follows (160/800 mg PO 2 times a day for one year) or a combination of doxycycline (100 mg orally two times a day for one year) and hydroxychloroquine (200 mg to 3- times a day for one year). Patients who are allergic to sulfur must receive oral penicillin or ampicillin. Clinical improvement occurs very quickly, fever and joint pain disappear within a few days. The intestinal symptoms usually resolve within 1-4 weeks. To confirm the therapeutic response, a PCR test in the stool, saliva or other tissue can be performed.

However, other experts recommend a repeat biopsy with microscopy after one year to document bacteria (not only macrophages, which may persist for years after successful treatment) in conjunction with a PCR test. Relapses are frequent and can occur even years later. If there is a suspicion of a decline, small intestine biopsies are obtained or PCR assays performed (independently of the affected organ system) to detect possibly free bacteria. Summary Infection with the bacteria T. whippelii affects many organs, including the GIT. The involvement of the intestinal mucosa causes malabsorption. A suspicion of Whipple’s disease is among white middle-aged men who have arthritis and abdominal pain, weight loss, diarrhea or other symptoms of malabsorption. What is needed is an endoscopic small bowel biopsy. Long-Term treatment with antibiotics is necessary; relapses are frequent.

Since Whipple’s disease is an infection by the bacterium Tropheryma whipplei. At first, the bacteria affects the lining of the small bowel mucosa and produces small lesions in the intestinal wall. The bacteria also damage fine projections such as hair (villi) lining the small intestine. Over time, the infection can spread to other parts of the body.

Not much is known about the bacteria. Although it seems to be very present in the environment, scientists do not know exactly where it comes from or how it is transmitted to human beings. Not all carriers of the bacteria suffer from the disease. Some researchers believe that people who have the disease may have a genetic defect in the response of the immune system, and this makes them more vulnerable to getting sick when they are exposed to the bacteria.

Whipple’s disease is very rare, affects less than one in a million people.

Risk factor’s
The risk factors for Whipple’s disease have not been clearly identified, because very little is known about the bacteria that cause this disease. Based on the available reports, it is very likely to affect the following population:

Men who are aged between 40 and 60 years old
White people of the United States and Europe
Farmers and other people who work outdoors and who are in frequent contact with sewage or wastewater
Complications
The lining of the small intestine has fine projections such as hair (villi) that help the body absorb nutrients. Whipple’s disease damages the villi and decreases the absorption of nutrients. Nutritional deficiencies are prevalent in people with Whipple’s disease and can cause fatigue, weakness, thinning and joint pain.

Whipple’s disease is a progressive and possibly fatal disease. Although the infection is exceptional, related deaths continue to be reported, due in large part to late diagnoses and treatment delays. Death often occurs because of the spread of infection to the central nervous system, which can cause irreversible damage.

Treatment
The treatment of Whipple’s disease consists of antibiotics, alone or in combination, capable of destroying the bacteria that cause the infection.

The treatment is prolonged (in general, it lasts one or two years), and the purpose is to destroy the bacteria. But relief of symptoms usually occurs faster, usually within the first or second week. Almost all people who do not have brain or nervous system complications recover completely after a complete course of antibiotics.

When antibiotics are chosen, doctors often select those that not only eliminate intestinal infections, but also cross the blood-brain barrier (a layer of tissue that surrounds the brain) to kill bacteria that may have entered the brain and into the brain. the central nervous system.

Due to the long cycle of antibiotics, the doctor will have to control the evolution of this condition due to the possible development of drug resistance. If there is a relapse during treatment, the doctor can change the antibiotics.

Treatment for standard cases
In almost all cases, treatment for Whipple’s disease begins with two to four weeks of intravenous administration of ceftriaxone (Rocephin) or penicillin. After this initial treatment, you may have to take a course of sulfamethoxazole-trimethoprim (Bactrim, Septra) orally, for one or two years. A shorter duration of antibiotic treatment may cause a relapse.

Possible side effects of ceftriaxone and sulfamethoxazole-trimethoprim include mild diarrhea, nausea, and vomiting.

Treatment of serious cases
If you have neurological symptoms, you could start immediately with a 12 to 18 month cycle of doxycycline (Vibramycin) combined with the antimalarial hydroxychloroquine (Plaquenil). They may also give you long-term antibiotics that reach the cerebrospinal fluid and brain, such as sulfamethoxazole-trimethoprim.

Possible side effects of doxycycline encompass loss of appetite, nausea, vomiting and sensitivity to sunlight. Hydroxychloroquine can cause loss of appetite, diarrhea, headaches, stomach cramps and dizziness.

Relief of symptoms
Symptoms should get better within one to two weeks after starting antibiotic treatment, and should disappear completely within a month.

But even though symptoms improve quickly, other laboratory tests may reveal the presence of bacteria for two or more years after starting antibiotics. Follow-up tests will help the doctor establish when you can stop taking antibiotics. Through regular monitoring, the development of resistance to a particular drug can also be detected; this is usually manifested by the absence of improvement in symptoms.

Even after a successful treatment, Whipple’s disease can reappear. Doctors usually advise regular checks. If you had a recurrence of the disease, you will have to repeat the antibiotic treatment.

Health Life Media Team

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