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Whipple’s Disease

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Whipple’s Disease

Whipple’s Disease

Whipple’s disease is an infectious disease caused by Tropheryma Whipple- a bacterium and causative organism.  It is a rare systemic disease that affects some or even whole parts of the body. It mainly affects the digestive system and deters the body’s absorption of nutrients, as well as changes in the joints, lymph nodes, heart, and […]

Symptoms

The symptoms of Whipple's disease differ depending on which organs are most affected; and the stage of the disease. 

The most common symptom of Whipple disease is intestinal malabsorption. It causes:

  • Weight loss
  • Abdominal pain
  • Diarrhea

Other symptoms include: 

  • Fever
  • Polyarthralgia (joint pain)
  • Arthritis (joint inflammation)
  • Anemia
  • Changes in skin pigmentation
  • Chronic cough and pleural pain

Less common symptoms of the disease include:

  • Peripheral edema
  • Lymphadenopathy (swollen lymph nodes, especially mesenteric)
  • Inflammation of the eyes
  • Pleurisy
  • Recurrent tenosynovitis

Symptoms by stage

First stage

At stage 1 of the disease, the patient complains of intermittent symptoms like: 

  • Joint pain - can occur for a short time, sometimes arthritis is diagnosed, but it appears rapidly and suddenly disappears
  • Periodic increase in body temperature, which cannot be associated with colds or inflammatory diseases
  • Peripheral lymph nodes increase in size, but at the same time, are painless.
  • Hyperpigmentation- mainly on the face and thighs

Stage 1 Whipple's disease can last for several years, up to a decade. Doctors prescribe treatment based on the patient's complaints, give temporary relief to the patient, but the infection continues to develop.

Second stage

At the onset of stage 2, the disease affects the digestive system. A patient may experience:

  • Frequent diarrhea - up to 15 times a day, regardless of the quantity and quality of food taken. 
  • Abdomen pain immediately after a meal
  • A sharply decreasing body weight- up to cachexia.

Third stage

At stage 3, Whipple's disease is specifically systemic - not only the intestines are affected, but also other organs/systems. It is during this period that pronounced symptoms appear:

  • Cough, shortness of breath, separation of a large amount of sputum, and in some cases, bronchospasm appears
  • Signs of endocarditis - changes in the heart wall;
  • "Night blindness" and inflammation of the eyes (mainly the membrane of the organ is affected).

Additionally, it also affects the nervous system. Whipple's neurological symptoms during stage 3 include dementia, memory loss, lack of attention, difficulty in walking, convulsions, and paralysis. All these symptoms do not appear instantly; at first, there is frequent irritation, depression, and migraine. 

Convulsions first appear with small twitching of the upper / lower extremities, and paralysis begins to affect the patient gradually (usually from the upper extremities)

Causes

Whipple's disease is caused by a bacterium called Tropheryma whippelii. This bacillus-like bacterium is widespread in the environment; however, it is found primarily in water treatment plants. The conditions that contribute to the infection are not yet known.

However, several studies indicated that immunogenetics is a possible factor for etiopathogenesis. Defective functions of HLA genes and a decrease in the immune response of T-lymphocytes (particularly in Th1 cells) show a high risk of developing Whipple's disease. But so far, these studies have not been confirmed.

More about Treatment

Whipple's disease is an infectious disease caused by Tropheryma Whipple- a bacterium and causative organism.  It is a rare systemic disease that affects some or even whole parts of the body. It mainly affects the digestive system and deters the body's absorption of nutrients, as well as changes in the joints, lymph nodes, heart, and lungs.

Whipple's disease diagnosis

Since the disease causes a wide variety of symptoms, gradually progresses, and signs are similar to many other conditions, the diagnosis is difficult. The patient will have to undergo a complete examination - it is necessary to differentiate Whipple's disease precisely. The diagnostics method is comprehensive, differential, with a comparison of symptoms, taking into account an overall perspective. All complaints of the patient, previous illnesses are taken into consideration. The doctor will pay special attention to the regions of the digestive system.  Whipple disease is diagnosed by histological examination following a biopsy of lymph nodes or intestines. The analysis allows you to identify rod-shaped bacteria (phagocytized or free) under an electron microscope. It also helps to reveal other specific changes, such as the level of the lamina propria of the mucous membrane of the small intestine or other tissues - swollen macrophages with a Schiff's reagent. To carry samples of cerebrospinal fluid, lymph, and synovial fluid, the doctor may perform culture studies, genetic tests, and molecular diagnostics techniques, including  PCR, to confirm the disease.

Differential diagnosis

The doctor also performs a differential diagnosis for Whipple disease for conditions that cause similar symptoms, including:
  • seronegative polyarthritis
  • Ankylosing spondylitis ( Bechterew's disease );
  • Culture-negative endocarditis
  • Vasculitis
  • Malabsorption syndrome
  • Lymphoma
  • Cerebrovascular diseases
  • Dementia
  • HIV infection
  • Atypical mycobacteriosis
  • Sarcoidosis.

Whipple's disease treatment

Treatment for Whipple's disease involves the use of antibiotics to kill bacteria, first intravenously, and then oral therapy for 12 months. The most commonly used drugs are tetracycline, chloramphenicol, chlortetracycline, sulfasalazine, ampicillin, penicillin, and trimethoprim/sulfamethoxazole. Currently, the most common therapy for Whipple's disease is the combination of trimethoprim + sulfamethoxazole. Another alternate combination of drugs consists of cephalosporins or penicillins followed by tetracycline. The treatment is long-term and can last for at least one year. In most cases, a complex conservative technique is used, including dietary nutrition and medication. Antibiotic therapy usually correlates with good results. Diet during treatment During the treatment regimen, it is necessary to eat healthily and keep a balanced diet so that the body can recover losses that occur due to nutritional deficiency. Professionals like nutritionists may select your diet depending on the conditions. It is necessary to consistently maintain immunity so that infections and bacteria do not spread to other systems or organs outside the intestines. Drug therapy, along with intake of vitamins B12, A, E, K, D, as well as folic acid and iron, is complimentary. Diet is a component of treatment. Common foods recommended during treatment:
  • Sour milk products such as yogurt or kefir (lactic acid)
  • Cooked or baked seasonal vegetables (carrots, potatoes)
  • Boiled eggs or omelet 
  • Dairy-free cereals (rice, semolina, buckwheat)
  • Vegetable soups in low-fat broth
  • Low-fat dietary meats and fish in baked, stewed, or boiled form
Foods to avoid:
  • Smoked meats
  • Marinades
  • Pickles
  • Raw vegetables
  • Spicy, fatty, fried, and acidic foods
  • Alcohol and black coffee
  • Legumes
  • Lard and fast food products

Whipple disease treatment abroad

Treatment of Whipple's disease abroad is possible in many foreign clinics. In European clinics, treatment is long-term antibiotic therapy with the prescription of drugs, mainly of the tetracycline series. Depending on the severity of the disease, treatment can last from several months to two years. Along with antibiotics, the doctor prescribes symptomatic therapy aimed at reducing symptoms. Whipple's disease is curable, but if left untreated, the prognosis is disappointing. A neglected second stage can be fatal.  It leads to death as a result of damage to the central nervous system. With adequate antibiotic therapy and proper diet, you can recover from the disease rapidly.

FAQ

What is Whipple's Disease?

  • Whipple's disease is a  rare systemic disease caused by a bacterium called Tropheryma whippelii. The treatment course is long term. This condition causes symptoms like lymph nodes, malabsorption, diarrhea, abdominal pain, and weight loss.
  • The disease got its name from the name of the American pathologist George Whipple, who first discovered it and described the characteristic symptoms in 1907.

What organs does Whipple disease affect?

  • Whipple's disease is a disease in which nearly all organs can be affected by the bacterium Tropheryma whipplei. It mainly affects the small intestine but can cause complications to other organs, including the spleen, heart, lungs, liver, kidneys, joints, eyes, and the central nervous system.

What is the most common complication of Whipple disease?

The disease may lead to complications like:

  • Lack of adrenal function
  • Anemia
  • Cerebral edema
  • Extreme exhaustion of the body.
  • Pulmonary, renal, and heart failure

Some complications of Whipple's disease are treated with surgery. For example, for hydrocephalus, bypass surgery is performed. To avoid complications, you need to be attentive to your own body, consult a doctor on time. There is no prophylaxis for Whipple's disease, but it is rare: one case occurs in more than 1 million of the world's population. To avoid it, you need to strengthen the immune system, lead a healthy lifestyle, and give the body time to rest and recover. 

What are the risk factors for developing  Whipple disease? 

  • The disease is common in people working at wastewater treatment plants and in farmers in contact with soil and animals, suggesting that the infection is from these sources.
  • Men: Whipple's disease mainly affects men between the ages of 30-60.

What is the differential diagnosis performed with Whipple's disease?

Symptoms such as weight loss, diarrhea, weakness, swollen lymph nodes necessitate the differential diagnosis of Whipple's disease with the following:

  • Lymphadenopathy
  • Cancerous tumor
  • Crohn's disease
  • Ulcerative colitis
  • Zollinger-Ellison syndrome
  • Enterocolitis
  • Sprue
  • Addison's disease

Top Doctors For Whipple’s Disease Treatment

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Dr. B. S. Ramakrishna Digestive – Gastro Enterology | Gender: Male | Experience: 25 years | Hospital: SIMS Hospital, Chennai
Dr. Patta Radhakrishna Digestive – Gastro Enterology | Gender: Male | Experience: 25 years | Hospital: SIMS Hospital, Chennai
Dr. Abhishek Jain Digestive – Gastro Enterology | Gender: Male | Experience: 10 years | Hospital: Narayana Hospital
Dr. Anand Dotihal Digestive – Gastro Enterology | Gender: Male | Experience: 10 years | Hospital: Manipal Hospitals, Bengaluru
Dr. Divakar Jain Digestive – Gastro Enterology | Gender: Male | Experience: 13 years | Hospital: Kokilaben Dhirubhai Ambani Hospital
Dr. Gaurav Mehta Digestive – Gastro Enterology | Gender: Male | Experience: 15 years | Hospital: Kokilaben Dhirubhai Ambani Hospital
Dr. Dattatray Solanke Digestive – Gastro Enterology | Gender: Male | Experience: 8 years Hospital: Kokilaben Dhirubhai Ambani Hospital
Prof. Dr. Ömer Necip Aytuğ Digestive – Gastro Enterology | Gender: Male | Experience: 39 years | Hospital: Hisar Intercontinental
Dr. Kaushal Madan Digestive – Gastro Enterology | Gender: Male | Experience: 10 years | Hospital: Max Super Speciality Hospital, Saket
Dr. Vivek Raj Digestive – Gastro Enterology | Gender: Male | Experience: 20 years | Hospital: Max Super Speciality Hospital, Saket
Dr. Shailesh Kumar Digestive – Gastro Enterology | Gender: Male | Experience: 15 years | Hospital: Thumbay Hospital, Ajman
Dr. Piyush Somani Digestive – Gastro Enterology | Gender: Male | Experience: 5 years | Hospital: Thumbay Hospital, Dubai
Dr. Syed Naveed Azam Digestive – Gastro Enterology | Gender: Male | Experience: 10 years | Hospital: RAK Hospital
Dr. Agkop Avakian Digestive – Gastro Enterology | Gender: Male | Experience: 26 years | Hospital: Saudi German Hospital
Dr. Najib Zeidan Digestive – Gastro Enterology | Gender: Male | Experience: 10 years | Hospital: Saudi German Hospital
Dr. Mustafa El Hakam Digestive – Gastro Enterology | Gender: Male | Experience: 10 years | Hospital: Saudi German Hospital
Dr. Arindam Ghosh Digestive – Gastro Enterology | Gender: Male | Experience: 28 years | Hospital: Saudi German Hospital
Dr. Kadry Barry Digestive – Gastro Enterology | Gender: Male | Experience: 38 years | Hospital: Saudi German Hospital
Dr. Yogesh Batra Digestive – Gastro Enterology | Gender: Male | Experience: 29 years | Hospital: Apollo Indraprastha

Top Hospitals For Whipple’s Disease Treatment

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Columbia Asia Hospital, Bengaluru Columbia Asia is an international healthcare group operating a chain of modern hospitals across Indi
Kerala Institute of Medical Sciences (KIMS), Trivandrum KIMS HEALTHCARE GROUP is one of Asia’s leading multi-specialty hospital networks focussed on provi
Peerless Hospital, Kolkata 400 bed Multi-Specialty Peerless Hospital & B.K.Roy Research Centre is build around the core princip
Ramesh Hospital, Vijayawada Ramesh Hospital’s Main Centre flagship unit, located in the heart of Vijayawada, has been offering
Primus Super Speciality Hospital, Delhi Primus Super Speciality Hospital is a state of the art multi specialty hospital,conveniently located
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