Whipple's disease history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]; Bhagyashree Deshmankar M.B.B.S.[3]
Overview
Patients with Whipple's disease have various presentations. Most common symptoms of the classic Whipple's disease include joint pain, weight loss, diarrhea, and abdominal pain. 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
History
Obtaining history is important to find risk factors for the Whipple's disease. Other differentials specifically those which cause malabsorption must be ruled out. Specific areas of focus when obtaining the history, are outlined below:[1][2][3][4][5][6][7][8][9][10][11][12]
- Onset, duration and progression of symptoms
- History of consuming contaminated water or vegetables
- History of access to proper sanitation and toilets
- History of living in shelters
- History of similar symptoms in a family
- Medical history of immunosuppression therapy
- History of HIV infection
Common Symptoms
Whipple's disease is a systemic disease that involves multiple organs. Many of the patients present with gastrointestinal symptoms, while others presents with localized involvement of different organs.[1][2][3][4][5][6][7][8][9][10][11][12]
Non specific symptoms
Gastrointestinal system
- Diarrhea: The most common complaint
- Steatorrhea
- Abdominal pain
- Edema
Articular system
- Intermittent migratory arthralgias: The second most common complaint
- Arthritis affecting peripheral joints, such as knees, elbows, wrists, and shoulders
- Multiple joint involvement
Less Common Symptoms
Central nervous system symptoms
- Asymptomatic involvement with detection of Tropheryma whipplei DNA in CSF: The most common finding
- Focal CNS involvement:
- Forgetfulness
- Hemiparesis
- Personality changes
- Progressive cognitive decline
- Nystagmus
- Twitching of a muscle
- Hypothalamic involvement (rarely)
- Polydipsia
- Hyperphagia
- Change in libido
- Change in sleep wake cycle
- Eye movement abnormalities (pathognomic)
- CNS involvement usually has poor prognosis.
Ocular symptoms
Ocular involvement is rare and is often seen in patients with CNS disease. It can involve:
- Eye pain
- Eye redness
- Decreased vision
- Diplopia
Skeletal muscle symptoms
Cardiopulmonary symptoms
- Chest pain: It could be pleuritic
- Shortness of breath
- Palpitations
- Chronic cough
- Cyanosis
- Sudden cardiac death
Cutaneous symptoms
Renal symptoms
- Renal involvement is late in course, may be seen rarely.
References
- ↑ 1.0 1.1 Dutly F, Altwegg M (2001). "Whipple's disease and "Tropheryma whippelii"". Clin Microbiol Rev. 14 (3): 561–83. doi:10.1128/CMR.14.3.561-583.2001. PMC 88990. PMID 11432814.
- ↑ 2.0 2.1 Fenollar F, Puéchal X, Raoult D (2007). "Whipple's disease". N Engl J Med. 356 (1): 55–66. doi:10.1056/NEJMra062477. PMID 17202456.
- ↑ 3.0 3.1 Schneider T, Moos V, Loddenkemper C, Marth T, Fenollar F, Raoult D (2008). "Whipple's disease: new aspects of pathogenesis and treatment". Lancet Infect Dis. 8 (3): 179–90. doi:10.1016/S1473-3099(08)70042-2. PMID 18291339.
- ↑ 4.0 4.1 Marth, Thomas; Moos, Verena; Müller, Christian; Biagi, Federico; Schneider, Thomas (2016). "Tropheryma whipplei infection and Whipple's disease". The Lancet Infectious Diseases. 16 (3): e13–e22. doi:10.1016/S1473-3099(15)00537-X. ISSN 1473-3099.
- ↑ 5.0 5.1 Schoniger-Hekele, M.; Petermann, D.; Weber, B.; Muller, C. (2007). "Tropheryma whipplei in the Environment: Survey of Sewage Plant Influxes and Sewage Plant Workers". Applied and Environmental Microbiology. 73 (6): 2033–2035. doi:10.1128/AEM.02335-06. ISSN 0099-2240.
- ↑ 6.0 6.1 Bureš, Jan; Kopáčová, Marcela; Douda, Tomáš; Bártová, Jolana; Tomš, Jan; Rejchrt, Stanislav; Tachecí, Ilja (2013). "Whipple's Disease: Our Own Experience and Review of the Literature". Gastroenterology Research and Practice. 2013: 1–10. doi:10.1155/2013/478349. ISSN 1687-6121.
- ↑ 7.0 7.1 Dutly, F.; Altwegg, M. (2001). "Whipple's Disease and "Tropheryma whippelii"". Clinical Microbiology Reviews. 14 (3): 561–583. doi:10.1128/CMR.14.3.561-583.2001. ISSN 0893-8512.
- ↑ 8.0 8.1 Dolmans, Ruben A. V.; Boel, C. H. Edwin; Lacle, Miangela M.; Kusters, Johannes G. (2017). "Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections". Clinical Microbiology Reviews. 30 (2): 529–555. doi:10.1128/CMR.00033-16. ISSN 0893-8512.
- ↑ 9.0 9.1 Conly JM, Johnston BL (2001). "Rare but not so rare: The evolving spectrum of Whipple's disease". Can J Infect Dis. 12 (3): 133–5. PMC 2094813. PMID 18159328.
- ↑ 10.0 10.1 Fenollar, Florence; Lagier, Jean-Christophe; Raoult, Didier (2014). "Tropheryma whipplei and Whipple's disease". Journal of Infection. 69 (2): 103–112. doi:10.1016/j.jinf.2014.05.008. ISSN 0163-4453.
- ↑ 11.0 11.1 Keita, Alpha Kabinet; Brouqui, Philippe; Badiaga, Sékéné; Benkouiten, Samir; Ratmanov, Pavel; Raoult, Didier; Fenollar, Florence (2013). "Tropheryma whipplei prevalence strongly suggests human transmission in homeless shelters". International Journal of Infectious Diseases. 17 (1): e67–e68. doi:10.1016/j.ijid.2012.05.1033. ISSN 1201-9712.
- ↑ 12.0 12.1 Schwartzman, Sergio; Schwartzman, Monica (2013). "Whipple's Disease". Rheumatic Disease Clinics of North America. 39 (2): 313–321. doi:10.1016/j.rdc.2013.03.005. ISSN 0889-857X.