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Whipple Disease Symptoms and Treatment Guidelines

What is the treatment for Whipple disease? How is Whipple disease diagnosed? Can you die from Whipple’s disease? Let’s find out about Whipple disease symptoms and treatment!

Whipple Disease Definition

Whipple disease meaning – What is Whipple disease? Whipple’s disease is a rare infection that affects the whole body. It is caused by a bacteria called Tropheryma whipplei.

whipple disease symptoms and treatment guidelines - how is whipple disease transmitted

Whipple Disease Causes

What causes Whipple disease? What is the most common cause of Whipple disease?

Whipple disease is a rare multisystem disease that affects about 1 in 100,000 people. An infection causes it with the bacillus Tropheryma whipplei. It can happen at any age, but White men in their 40s to 60s are most likely to get it. No one knows where the infection came from, and there have been no cases of it being passed from person to person.

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Whipple Disease Diagnosis

  • Multiple-system illness.
  • Fever, swollen lymph nodes, and joint pain.
  • Loss of weight, inability to absorb nutrients, and constant diarrhea.
  • A duodenum biopsy showed macrophages that were positive for periodic acid-Schiff (PAS) and had the typical bacillus.

Differential Diagnosis

Whipple disease should be considered in patients who show signs of malabsorption, fever of unknown cause, lymphadenopathy, arthritis that is not caused by an infection, endocarditis that is not caused by an infection, or disease that affects more than one system. Whipple disease is easy to tell apart from other mucosal malabsorptive disorders, like celiac disease, with a small bowel biopsy.

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Whipple Disease Symptoms

Signs and symptoms of Whipple disease: What are some symptoms of Whipple disease?

There are many symptoms, but the most common ones are joint pain, diarrhea, stomach pain, and weight loss. Arthralgias, or non-deforming, migratory arthritis, is usually the first sign of arthritis for most people. Symptoms in the intestines happen in about 75% of cases.

They include stomach pain, diarrhea, malabsorption, bloating, gas, and steatorrhea. Loss of weight is the most common first sign that almost all patients show. Protein-losing enteropathy with low albumin levels and swelling can be caused by protein loss in the gut or lymphatic system.

When there are no stomach problems, the diagnosis is often not made for a few years. Over 50% of cases have a low-grade fever that comes and goes.

A physical exam may show low blood pressure (a late sign), a low-grade fever, and poor digestion. In addition, 50% of people have lymphadenopathy. Heart murmurs due to valvular involvement may be evident. Joints in the periphery may be swollen or warm, and there may be swelling in the periphery. Neurological findings have been mentioned above. Up to 40% of people with sun-exposed skin show signs of hyperpigmentation.

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Whipple Disease Histology

In 90% of cases, Whipple disease is diagnosed by taking an endoscopic biopsy of the duodenum and looking at its histology. This shows that the lamina propria is filled with PAS-positive macrophages that have gram-positive bacilli (which are not acid-fast) and that the lacteals have gotten bigger. Then, the cases are diagnosed by T whipplei-specific PCR or immunohistochemistry of duodenal biopsies, extraintestinal fluids (cerebrospinal, synovial), or tissue (lymph nodes, synovium, endocardium).

PCR has a 97% sensitivity and 100% specificity. Because 40% of people have a central nervous system infection without symptoms, the cerebrospinal fluid should always be tested for T whipplei by PCR.

Whipple Disease Treatment and Management Guidelines

Treatment of Whipple disease – What is the best treatment for Whipple disease?

In a few weeks, antibiotic treatment leads to a dramatic improvement in the patient’s condition. This is true even for some patients with neurologic involvement. However, no one knows what the best routine is.

Complete clinical response is usually seen within one to three months. However, up to one-third of patients who stop treatment may have a relapse. Because of this, at least a year of treatment is needed.

The best drugs are ones that can get into the brain. For example, with ceftriaxone 1 g intravenously twice a day or meropenem 1 g intravenously three times a day for 2 weeks, followed by trimethoprim-sulfamethoxazole 160/800 mg twice a day for 12 months, all 40 patients in a randomized controlled trial who were followed for 3 to 10 years went into remission.

After treatment, for histologic analysis and cerebrospinal fluid PCR, duodenal biopsies should be taken every six months again for at least a year. If there is no PAS-positive material, it means that clinical relapse is unlikely.

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Whipple Disease Prognosis

If the disease isn’t treated, it will kill you. Because some neurologic symptoms can last forever, the goal of treatment is to stop this from happening. After treatment, patients must be closely watched for signs of their symptoms returning.

I hope you understand Whipple’s disease symptoms and treatment guidelines.

About Micel Ortega

Dr. Micel Ortega, MD, PhD, is a highly respected medical practitioner with over 15 years of experience in the field of internal medicine. As a practicing physician, Dr. Micel has built a reputation for providing compassionate and evidence-based care to his patients. He specializes in the diagnosis and management of chronic conditions, including diabetes, hypertension, and heart disease. In addition to his clinical work, Dr. Micel has published extensively in top-tier medical journals on the latest advancements in internal medicine and has played an instrumental role in the development of innovative treatment options.

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