Medical history (history of illness) represents an important component in the diagnosis of Whipple disease. Family history Is there a frequent history of infectious disease in your family? Social history What is your profession? Current medical history/systemic history (somatic and psychological complaints). Do you suffer from abdominal pain, diarrhea, weight loss? Do you experience any … Whipple’s Disease: Medical History
Blood, hematopoietic organs-immune system (D50-D90). Sarcoidosis (Boeck’s disease) – inflammatory systemic disease primarily affecting the skin, lungs, and lymph nodes. Skin and subcutaneous (L00-L99). Vasculitis (vascular inflammation) Cardiovascular system (I00-I99) Endocarditis (endocardial inflammation). Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93). Malabsorption syndrome – disorder in nutrient absorption. Musculoskeletal system and connective tissue (M00-M99). Collagenosis, … Whipple’s Disease: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by Whipple’s disease: Eyes and eye appendages (H00-H59). Uveitis – inflammation of the middle eye skin. Cardiovascular system (I00-I99) Endocarditis (endocardial inflammation; second most common location). Myocarditis (inflammation of the heart muscle). Pericarditis (inflammation of the pericardium) with valvular insufficiency. Musculoskeletal … Whipple’s Disease: Complications
The following symptoms and complaints may indicate Whipple’s disease: Weight loss Enteropathic arthritis (oligoarthritis/occurrence of joint inflammation (arthritis) in fewer than 5 joints)/spondyloarthropathy/sacroiliitis (inflammation of sacroiliac joint between sacrum and ilium); most common first symptom: 18%; may precede intestinal (“affecting the intestine”) symptoms by up to 10 years!) Synovialitis (synovial inflammation). Lymphadenopathy (lymph node enlargement). … Whipple’s Disease: Symptoms, Complaints, Signs
Pathogenesis (disease development) Tropheryma whippelii has been detected in sewage treatment plants and in the stools of sewage treatment plant workers, as well as in the stools of healthy individuals. Human-to-human transmission has not yet been observed. Exactly how infection occurs is still the subject of studies. It is assumed that only people with impaired … Whipple’s Disease: Causes
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body temperature, body weight, body height; further: Inspection (viewing). Skin, mucous membranes, and sclerae (white part of the eye) [disorders in skin pigmentation; uveitis (inflammation of the middle skin of the eye)] Abdomen (abdomen) Shape … Whipple’s Disease: Examination
1st order laboratory parameters – obligatory laboratory tests. Small blood count Inflammatory parameters – CRP (C-reactive protein). Tropheryma whippelii PCR* (polymerase chain reaction) from a biopsy (tissue sample), stool, cerebrospinal fluid (nervous fluid); electron microscopy if necessary. Laboratory parameters 2nd order – depending on the results of the history, physical examination and the obligatory laboratory … Whipple’s Disease: Test and Diagnosis
Therapeutic target Rehydration (fluid balance). Elimination of bacteria Avoidance of complications Therapy recommendations Symptomatic therapy (analgesics (painkillers)/antipretics(antipyretic drugs) if necessary) including fluid replacement, i.e., oral rehydration for signs of dehydration (fluid deficiency; >3% weight loss): administration of oral rehydration solutions (ORL), which should be hypotonic, between meals (“tea breaks”) for mild to moderate dehydration. Antibiosis … Whipple’s Disease: Drug Therapy
Obligatory medical device diagnostics. Gastroduodenoscopy (endoscopy of the stomach and duodenum) [duodenal biopsy: detection of PAS-positive macrophages in the lamina propria of the duodenum/duodenum]. Colonoscopy (colonoscopy) with biopsies (tissue sampling) stained with PAS stain. Important Notice. A negative small bowel histology by no means excludes Whipple’s disease!
