Whipple's disease
Whipple's disease (intestinal lipodystrophy) is a systemic chronic infectious disease caused by the gram-positive rod-shaped bacterium Tropheryma whipplei . The small intestine is most affected, especially the duodenum and jejunum. Other organs are the brain, eyes, heart, lungs, spleen, colon, joints and then the whole organism.
Etiopatogenesis[edit | edit source]
- The disease is relatively rare .
- occurs mainly in white men between the ages of 40 and 60
The exact role of Tropheryma whipplei in the pathogenesis of the disease is unknown. A genetic predisposition to the disease is assumed .
The clinical picture[edit | edit source]
Pathological changes in the intestine are manifested by malabsorption , the main cause of which is probably blockage of lymphatic tissue :
- abdominal pain ;
- diarrhea ;
- steatorrea ;
- weight loss .
Most patients have:
- remittent fever
- migratory arthralgia or arthritis of large joints.
In the advanced stage of the disease, the nervous system and the heart are particularly affected . In the terminal stage app cachexia , memory loss and hearing impaired visus, and other signs of organic disease may appear
Diagnosis[edit | edit source]
From a small bowel biopsy;
- PCR ;
- PAS-reaction - detection of sickle-shaped substances in macrophages accumulated in the villi of the intestinal mucosa;
- bacterial culture
The bacteria has Gram-positive structure of the cell wall, but Gram stain is almost non-staining.
Treatment[edit | edit source]
The prognosis of the disease is uncertain and untreated is life threatening . The drug of choice is the cephalosporin and antibiotic ceftriaxone , administered intravenously over 14 days. It can be replaced by a combination of penicillin + streptomycin. This is followed by long-term treatment with co-trimoxazole or doxycycline. The therapeutic effect should appear within 1-3 weeks of therapy. Premature termination of therapy is dangerous , which leads to frequent relapses of the disease.
References[edit | edit source]
Source[edit | edit source]
External links[edit | edit source]
References[edit | edit source]
- BENEŠ, Jiří. Infectious medicine. 1st edition. Galén, 2009. 651 pp. ISBN 978-80-7262-644-1 .
- POVÝŠIL, Ctibor, Ivo ŠTEINER and Jan BARTONÍČEK, et al. Special pathology. 2nd edition. Prague: Galén, 2007. 430 pp. ISBN 978-807262-494-2 .
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