|
|
| (37 intermediate revisions by 2 users not shown) |
| Line 1: |
Line 1: |
| __NOTOC__
| | ==pic== |
| {{Whipple's disease}} | | {| |
| {{CMG}};{{AE}}{{BHA}}
| | |[[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]] |
| | |} |
| | <br style="clear:left" /> |
|
| |
|
| ==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]] |
| *Patients with Whipple's disease have varied presentation.
| | <br style="clear:left" /> |
| *Most common symptoms of Classical Whipple's disease include joint pain weight loss diarrhea and arthropathy. Various other organ systems can be involved in Whipple's disease including central nervous system, cardiac system, renal system, skeletal muscles and pulmonary system.
| |
|
| |
|
| ==History and Symptoms==
| | {{#ev:youtube|7TWu0_Gklzo}} |
|
| |
|
| == Common Symptoms == | | ==Table== |
| | | {| |
| ==== Non specific symptoms ==== | | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Complications |
| * [[Fever]]
| | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Polymyositis |
| * [[Weight loss]]
| | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dermatomyositis |
| | | |- |
| ====Gastrointestinal system====
| | ! align="center" style="background:#DCDCDC;" + |[[Cancer|Malignancy]] |
| * [[Diarrhea]]: The most common complaint
| | | align="left" style="background:#F5F5F5;" + | |
| * [[Steatorrhea]]
| | *[[Lung]] |
| * [[Abdominal pain]]
| | | align="center" style="background:#F5F5F5;" + | |
| * Occult [[mucosal bleeding]]
| | *[[Lung]] |
| * [[Ascites]]
| | |} |
| * [[Hepatosplenomegaly]]
| |
| * [[Hepatitis]]
| |
| | |
| ====Articular system====
| |
| * Intermittent migratory [[arthralgias]]: The second most common complaint
| |
| * [[arthritis]]: affecting peripheral joints like knees elbows wrists
| |
| * Multiple [[joint]] involvement
| |
| | |
| == Less Common Symptoms ==
| |
| '''[[Central nervous system]] :'''
| |
| * Asymptomatic involvement with detection of T. whipplei DNA in CSF: most common finding.
| |
| * Focal CNS involvement may present with clinical symptoms like
| |
| * [[dementia]],
| |
| * [[cerebral ataxia]],
| |
| * [[hemiparesis]],
| |
| * personality changes,
| |
| * [[opthalmoplegia]],
| |
| * [[nystagmus]]
| |
| * [[supranuclear opthalmoplegia]] at presentation in about 50% patients
| |
| * [[myoclonus]]. at presentation in about 25%
| |
| * Hypothalmic involvement seen as [[polydipsia]] , [[hyperphagia]] , change in [[libido]] and sleep wake cycle: rarely
| |
| * :Eye movement abnormalities Oculomasticatory myorhythmia (OMM) and oculofacial-skeletal myorhythmia (OSFM) : pathognomic of Whipple's disease
| |
| * CNS involvement usually has poor prognosis. <ref name="pmid17202456">{{cite journal| author=Fenollar F, Puéchal X, Raoult D| title=Whipple's disease. | journal=N Engl J Med | year= 2007 | volume= 356 | issue= 1 | pages= 55-66 | pmid=17202456 | doi=10.1056/NEJMra062477 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17202456 }} </ref> <ref name="pmid11432814">{{cite journal| author=Dutly F, Altwegg M| title=Whipple's disease and "Tropheryma whippelii". | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 3 | pages= 561-83 | pmid=11432814 | doi=10.1128/CMR.14.3.561-583.2001 | pmc=88990 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11432814 }} </ref>
| |
| '''Ocular involvement''' : rare and can involve: <ref name="pmid11432814" />
| |
| * [[uveitis]],
| |
| * [[retinitis]] ,
| |
| * [[vitritis]]
| |
| * [[retrobulbar neuritis]]
| |
| * [[papilledema]] .
| |
| * Ocular involvement is often seen in patients with CNS disease. <ref name="pmid11432814">{{cite journal| author=Dutly F, Altwegg M| title=Whipple's disease and "Tropheryma whippelii". | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 3 | pages= 561-83 | pmid=11432814 | doi=10.1128/CMR.14.3.561-583.2001 | pmc=88990 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11432814 }} </ref>
| |
| '''Skeletal muscle''' '''involvement'''
| |
| * seen as [[myalgias]] and muscle cramps <ref name="pmid17202456">{{cite journal| author=Fenollar F, Puéchal X, Raoult D| title=Whipple's disease. | journal=N Engl J Med | year= 2007 | volume= 356 | issue= 1 | pages= 55-66 | pmid=17202456 | doi=10.1056/NEJMra062477 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17202456 }} </ref>
| |
| '''Cardiac involvement''' :may have varied presentation .<ref name="pmid17202456" /> <ref name="pmid11432814" />
| |
| * [[pericarditis]]
| |
| * [[myocarditis]]
| |
| * [[heart failure]]
| |
| * [[sudden Cardiac death]]
| |
| * [[Endocarditis]] : associated with negative blood cultures. Endocarditis is often preceded by [[arthritis]] and [[arthralgias]] .<ref name="pmid17202456">{{cite journal| author=Fenollar F, Puéchal X, Raoult D| title=Whipple's disease. | journal=N Engl J Med | year= 2007 | volume= 356 | issue= 1 | pages= 55-66 | pmid=17202456 | doi=10.1056/NEJMra062477 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17202456 }} </ref> <ref name="pmid11432814">{{cite journal| author=Dutly F, Altwegg M| title=Whipple's disease and "Tropheryma whippelii". | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 3 | pages= 561-83 | pmid=11432814 | doi=10.1128/CMR.14.3.561-583.2001 | pmc=88990 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11432814 }} </ref>
| |
| '''Pulmonary involvement <ref name="pmid11432814" />'''
| |
| * manifest as pleuritic chest pain
| |
| * non productive cough
| |
| * [[dyspnea]] | |
| * Chest x-ray often shows [[pleural effusion]] , pulmonary infiltration, or granulomatous mediastinal adenopathy. Often abdominal lymph nodes may be involved.
| |
| '''Hematological finding'''
| |
| * [[anemia]] which may be due to malabsorption or mucointestinal bleeding.<ref name="pmid11432814">{{cite journal| author=Dutly F, Altwegg M| title=Whipple's disease and "Tropheryma whippelii". | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 3 | pages= 561-83 | pmid=11432814 | doi=10.1128/CMR.14.3.561-583.2001 | pmc=88990 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11432814 }} </ref>
| |
| '''Cutaneous finding'''
| |
| * [[melanoderma]] : less frequently reported these days as Whipple's disease is increasingly recognized early. <ref name="pmid17202456">{{cite journal| author=Fenollar F, Puéchal X, Raoult D| title=Whipple's disease. | journal=N Engl J Med | year= 2007 | volume= 356 | issue= 1 | pages= 55-66 | pmid=17202456 | doi=10.1056/NEJMra062477 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17202456 }} </ref> | |
| '''Renal involvemen'''t : late in course, may be seen rarely. <ref name="pmid17202456">{{cite journal| author=Fenollar F, Puéchal X, Raoult D| title=Whipple's disease. | journal=N Engl J Med | year= 2007 | volume= 356 | issue= 1 | pages= 55-66 | pmid=17202456 | doi=10.1056/NEJMra062477 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17202456 }} </ref>
| |
| | |
| ==References==
| |
| {{Reflist|2}}
| |
| | |
| {{WH}}
| |
| {{WS}}
| |
