Abstract
Whipple's disease is a chronic infectious systemic disease caused by the bacterium Tropheryma whipplei. Nondeforming arthritis is frequently an initial complaint. Gastrointestinal and general symptoms include marked diarrhoea (with serious malabsorption), abdominal pain, prominent weight loss, and low-grade fever. Possible neurologic symptoms (up to 20%) might be associated with worse prognosis. Diagnosis is based on the clinical picture and small intestinal histology revealing foamy macrophages containing periodic-acid-Schiff- (PAS-) positive material. Long-term (up to one year) antibiotic therapy provides a favourable outcome in the vast majority of cases. This paper provides review of the literature and an analysis of our 5 patients recorded within a 20-year period at a tertiary gastroenterology centre. Patients were treated using i.v. penicillin G or amoxicillin-clavulanic acid + i.v. gentamicin for two weeks, followed by p.o. doxycycline (100 mg per day) plus p.o. salazopyrine (3 g per day) for 1 year. Full remission was achieved in all our patients.
Highlights
Whipple’s disease is a rare, chronic, and infectious systemic disease caused by the bacterium Tropheryma whipplei, a member of the diverse order of Actinomycetales, usually found in soil [1]
Physical findings include arthritis (90%), peripheral lymphadenopathy, low-grade fever, neurologic signs, polyserositis, uveitis, cheilosis, glossitis, purpura, and splenomegaly
Whipple’s disease is chronic infectious systemic disease caused by the bacterium Tropheryma whipplei
Summary
Whipple’s disease is a rare, chronic, and infectious systemic disease caused by the bacterium Tropheryma whipplei, a member of the diverse order of Actinomycetales, usually found in soil [1]. 2. Whipple published this report only two years after his graduation from the Johns Hopkins University in 1905 He won the Nobel Prize in physiology and medicine (for his “discovery concerning liver therapy of anaemia” in 1934). Whipple described his case as “gradual loss of weight and strength, stools consisting of neutral fat and fatty acids, indefinite abdominal signs, and a peculiar multiple arthritis” [2]. On the basis of this gene sequence, the organism was classified as an actinobacterium and successfully was cultivated in vitro in HEL cells for the first time in 1999 [6]. The name of this bacterium—Tropheryma whipplei—is derived from Greek “trophe” (nourishment and food) and “eryma” (fence and barrier)
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