Whipple

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Whipple disease is a bacterial infection caused by a gram-positive bacterium, Tropheryma whippelii.

Whipple disease apart from affecting small intestine also affects heart, lungs, brain, and joints.
Major sign and symptom of Whipple disease include -joints pain, disrrhoea , weight loss , abdominal pain and fever .

Whipple disease interfers with the process of normal digestion by preventing normal food breakdown of fats and carbohydrates resulting in reduced body’s ability to absorb nutrients .
Age/Sex prevalance of whipple disease

Whipple disease is more common in males than females, and is common in middle –aged and elderly persons.

Causes of whipple disesae

Bacteria called Tropheryma whipplei (T. whipplei) cause Whipple’s disease. T. whipplei infection can cause internal sores, also called lesions, and the thickening of tissues.

Whipple disease Signs and Symptoms

• arthralgias, arthritis, fever, and diarrhea.
• Lymphadenopathy may be present.
• If Whipple disease affects the small intestine, steatorrhea( presence of excess fat in feces ) is present.
• Majority of patients with Whipple disease present with weight loss, and 70% of patients with Whipple disease complain of either diarrhea or arthralgias.
• GI(gastro intestinal bleeding )bleeding can also be found in patients of Whipple disease
• Cardiac involvement occurs in approximately 30% of cases.
• Patients with Whipple disease may have any of the physical findings associated with malabsorption such as –

Cachexia( loss of body mass )

  • Distended abdomen
  • ” href=”../disease/glossitis/”>Glossitis
  • angular cheilitis
  • Chvostek or Trousseau sign (secondary to hypocalcemia)
  • Gingivitis and parafollicular hemorrhages (secondary to vitamin C deficiency)
  • Night blindness (secondary to vitamin A deficiency)>
  • Visible peristalsis
  • Hyperpigmentation around the orbital and malar areas of the face
  • • Vision problems
    • Dementia
    • Facial numbness
    • Headache
    • Difficulty walking
    • Skin darkening
    • Enlarged lymph nodes
    • Chronic cough
    • Chest pain
    • Heart failure

    Investigations of whipple disease

    Careful evaluation of symptoms, endoscopy, and biopsy with tissue staining.

    Electron microscopy and polymerase chain reaction (PCR) testing are used to confirm a diagnosis.PCR testing can detect and identify extremely low levels of bacterial DNA in tissues and body fluids.

    Endoscopy will be used to examine the lining of the small intestine.

    Electron microscopy.

    Differential diagnosis of whipple disease

    • Celiac sprue
    • Malabsorption
    • Abdominal angina

    Treatment of whipple disease

    Antibiotic treatment

    IV antibiotics used to treat Whipple’s disease include ceftriaxone (Rocephin) and penicillin G (Pfizerpen) plus streptomycin.

    Trimethoprim/sulfamethoxazole (Septra, Bactrim), a combination oral antibiotic that can enter the cerebrospinal fluid and brain.

    Prognosis of whipple disease

    Without treating condition is fatal.

    Complications of whipple disease

    • Weight loss
    • Nutritional defeciencies
    • Brain damage
    • Heart valve damage

    Diet / management of whipple disease

    • Proper fluid and electrolyte replacement
    • Iron or folate supplements may be required to correct anemia.
    • Vitamin D and calcium, and magnesium may be necessary to maintain calcium homeostasis.
    • Vitamin K is used to correct coagulopathy.
    • The diet should be appropriately high in calories, protein, and other vitamins because most of the patients are malnourished.

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