|[[image:LowKECG.png|thumb|700px|center|An ECG in a person with a potassium level of 1.1 showing the classical ECG changes of ST segment depression, inverted T waves, large U waves, and a slightly prolonged PR interval. By James Heilman, MD - Own work, CC BY-SA 3.0]]
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==Overview==
[[image:LowKECG.png|thumb|700px|right|An ECG in a person with a potassium level of 1.1 showing the classical ECG changes of ST segment depression, inverted T waves, large U waves, and a slightly prolonged PR interval. By James Heilman, MD - Own work, CC BY-SA 3.0]]
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
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Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
The progression to [disease name] usually involves the [molecular pathway].
The pathophysiology of [disease/malignancy] depends on the histological subtype.
==Pathophysiology==
{{#ev:youtube|7TWu0_Gklzo}}
===Pathogenesis===
==Table==
{|
*Whipple's disease is a rare bacterial systemic infection caused by [[Tropheryma whipplei]].<ref name="pmid18291339">{{cite journal |vauthors=Schneider T, Moos V, Loddenkemper C, Marth T, Fenollar F, Raoult D |title=Whipple's disease: new aspects of pathogenesis and treatment |journal=Lancet Infect Dis |volume=8 |issue=3 |pages=179–90 |year=2008 |pmid=18291339 |doi=10.1016/S1473-3099(08)70042-2 |url=}}</ref>
*[[Tropheryma whipplei]] is a [[periodic acid-Schiff stain]] positive, gram-positive [[bacillus]] of [[Actinomycetes]] family.<ref name="SchwartzmanSchwartzman2013">{{cite journal|last1=Schwartzman|first1=Sergio|last2=Schwartzman|first2=Monica|title=Whipple's Disease|journal=Rheumatic Disease Clinics of North America|volume=39|issue=2|year=2013|pages=313–321|issn=0889857X|doi=10.1016/j.rdc.2013.03.005}}</ref>
* The bacterium lives in soil and wastewater. Farmers and everyone who has any contact with contaminated soil and water are at high risk of the infection. <ref name="KeitaDiatta2013">{{cite journal|last1=Keita|first1=Alpha Kabinet|last2=Diatta|first2=Georges|last3=Ratmanov|first3=Pavel|last4=Bassene|first4=Hubert|last5=Raoult|first5=Didier|last6=Roucher|first6=Clémentine|last7=Fenollar|first7=Florence|last8=Sokhna|first8=Cheikh|last9=Tall|first9=Adama|last10=Trape|first10=Jean-François|last11=Mediannikov|first11=Oleg|title=Looking for Tropheryma whipplei Source and Reservoir in Rural Senegal|journal=The American Journal of Tropical Medicine and Hygiene|volume=88|issue=2|year=2013|pages=339–343|issn=0002-9637|doi=10.4269/ajtmh.2012.12-0614}}</ref>
*It is transmitted through oro-oral and feco-oral routes. The poor sanitation is associated with [[Tropheryma whipplei|T. whipplei]] infection. <ref name="KeitaBrouqui2013">{{cite journal|last1=Keita|first1=Alpha Kabinet|last2=Brouqui|first2=Philippe|last3=Badiaga|first3=Sékéné|last4=Benkouiten|first4=Samir|last5=Ratmanov|first5=Pavel|last6=Raoult|first6=Didier|last7=Fenollar|first7=Florence|title=Tropheryma whipplei prevalence strongly suggests human transmission in homeless shelters|journal=International Journal of Infectious Diseases|volume=17|issue=1|year=2013|pages=e67–e68|issn=12019712|doi=10.1016/j.ijid.2012.05.1033}}</ref>
*[[Lung]]
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*It is believed that human being is the only reservoir for this bacterium.<ref name="MarthMoos2016">{{cite journal|last1=Marth|first1=Thomas|last2=Moos|first2=Verena|last3=Müller|first3=Christian|last4=Biagi|first4=Federico|last5=Schneider|first5=Thomas|title=Tropheryma whipplei infection and Whipple's disease|journal=The Lancet Infectious Diseases|volume=16|issue=3|year=2016|pages=e13–e22|issn=14733099|doi=10.1016/S1473-3099(15)00537-X}}</ref>
*[[Lung]]
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*It invades [[Intestine|intestines]] primarily and then every other organ including the heart, CNS, joints, lymph nodes, skin, lungs and the eyes.
*Tissues are infected by macrophage infiltration contaminated by [[Tropheryma whipplei]]. T. whipplei multiplies in macrophages and monocytes. <ref name="pmid8903578">{{cite journal |vauthors=Marth T, Strober W |title=Whipple's disease |journal=Semin. Gastrointest. Dis. |volume=7 |issue=1 |pages=41–8 |year=1996 |pmid=8903578 |doi= |url=}}</ref>
* [[Tropheryma whipplei]] infection causes four different clinical manifestations: acute infection, the classic Whipple’s disease, asymptomatic carrier state, and localized chronic infection.<ref name="Marth2009">{{cite journal|last1=Marth|first1=Thomas|title=New Insights into Whipple’s Disease – A Rare Intestinal Inflammatory Disorder|journal=Digestive Diseases|volume=27|issue=4|year=2009|pages=494–501|issn=1421-9875|doi=10.1159/000233288}}</ref> <ref name="StreetDonoghue1999">{{cite journal|last1=Street|first1=Sara|last2=Donoghue|first2=Helen D|last3=Neild|first3=GH|title=Tropheryma whippelii DNA in saliva of healthy people|journal=The Lancet|volume=354|issue=9185|year=1999|pages=1178–1179|issn=01406736|doi=10.1016/S0140-6736(99)03065-2}}</ref>
* It is believed that host immunologic response to the microorganism plays an important role on the clinical manifestation of the disease.<ref name="pmid8903578">{{cite journal |vauthors=Marth T, Strober W |title=Whipple's disease |journal=Semin. Gastrointest. Dis. |volume=7 |issue=1 |pages=41–8 |year=1996 |pmid=8903578 |doi= |url=}}</ref>
===Immunologic response===
==Genetics==
There is no known causative genetic factor for Whipple's disease. However, there is an association between Whipple's disease and some immunologic defects.
*
*
==Associated Conditions==
The most important conditions associated with Whipple's disease include:
* HLA-B27 individuals:
* Defective T-cell immunity:
==Gross Pathology==
*On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
==Microscopic Pathology==
*On microscopic histopathological analysis, [[PAS stain|PAS]]-positive [[Macrophage|macrophages]] in the [[lamina propria]] containing non-acid-fast gram-positive [[bacilli]] are characteristic findings of Whipple's disease.<ref name="SchneiderMoos2008">{{cite journal|last1=Schneider|first1=Thomas|last2=Moos|first2=Verena|last3=Loddenkemper|first3=Christoph|last4=Marth|first4=Thomas|last5=Fenollar|first5=Florence|last6=Raoult|first6=Didier|title=Whipple's disease: new aspects of pathogenesis and treatment|journal=The Lancet Infectious Diseases|volume=8|issue=3|year=2008|pages=179–190|issn=14733099|doi=10.1016/S1473-3099(08)70042-2}}</ref>
Below images show the characteristic feature of Whipple's disease. foamy [[Macrophage|macrophages]] are present in the [[lamina propria]].<ref>https://commons.wikimedia.org</ref>
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File:Whipple disease low mag.jpg| Low magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)<ref> CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15357443</ref>
File:Whipple disease - intermed mag.jpg| Intermediate magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)<ref> CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15357450</ref>
File:Whipple disease high mag.jpg| High magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)<ref> CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15357481</ref>
File:Whipple disease very high mag.jpg| Very high magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)<ref> CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15357462</ref>
</gallery>
==References==
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Latest revision as of 02:27, 23 May 2019
pic
An ECG in a person with a potassium level of 1.1 showing the classical ECG changes of ST segment depression, inverted T waves, large U waves, and a slightly prolonged PR interval. By James Heilman, MD - Own work, CC BY-SA 3.0
An ECG in a person with a potassium level of 1.1 showing the classical ECG changes of ST segment depression, inverted T waves, large U waves, and a slightly prolonged PR interval. By James Heilman, MD - Own work, CC BY-SA 3.0
