Whipple's disease physical examination: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
m (Bot: Removing from Primary care) |
||
| (17 intermediate revisions by one other user not shown) | |||
| Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
{{Whipple's disease}} | {{Whipple's disease}} | ||
{{CMG}}; {{AE}} {{ | {{CMG}}; {{AE}} {{SSH}}; {{BHA}} | ||
==Overview== | ==Overview== | ||
Patients with Whipple's disease usually appear weak. Physical examination of patients with Whipple's disease is usually remarkable for [[weight loss]] and | Patients with Whipple's disease usually appear weak. Physical examination of patients with Whipple's disease is usually remarkable for [[weight loss]] and signs of [[vitamin deficiency]]. Further physical findings depend on the systems involved in the disease. Abnormal [[eye movements]] including oculomasticatory myorhythmia, or oculofacial-skeletal myorhythmia are pathognomonic for the Whipple's disease. | ||
==Physical Examination== | ==Physical Examination== | ||
*Physical examination of patients with Whipple's disease is usually remarkable for generalized weakness secondary to [[weight loss]]. | *Physical examination of patients with Whipple's disease is usually remarkable for generalized weakness secondary to [[weight loss]].<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><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="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><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><ref name="Schoniger-HekelePetermann2007">{{cite journal|last1=Schoniger-Hekele|first1=M.|last2=Petermann|first2=D.|last3=Weber|first3=B.|last4=Muller|first4=C.|title=Tropheryma whipplei in the Environment: Survey of Sewage Plant Influxes and Sewage Plant Workers|journal=Applied and Environmental Microbiology|volume=73|issue=6|year=2007|pages=2033–2035|issn=0099-2240|doi=10.1128/AEM.02335-06}}</ref><ref name="BurešKopáčová2013">{{cite journal|last1=Bureš|first1=Jan|last2=Kopáčová|first2=Marcela|last3=Douda|first3=Tomáš|last4=Bártová|first4=Jolana|last5=Tomš|first5=Jan|last6=Rejchrt|first6=Stanislav|last7=Tachecí|first7=Ilja|title=Whipple’s Disease: Our Own Experience and Review of the Literature|journal=Gastroenterology Research and Practice|volume=2013|year=2013|pages=1–10|issn=1687-6121|doi=10.1155/2013/478349}}</ref><ref name="DutlyAltwegg2001">{{cite journal|last1=Dutly|first1=F.|last2=Altwegg|first2=M.|title=Whipple's Disease and "Tropheryma whippelii"|journal=Clinical Microbiology Reviews|volume=14|issue=3|year=2001|pages=561–583|issn=0893-8512|doi=10.1128/CMR.14.3.561-583.2001}}</ref><ref name="DolmansBoel2017">{{cite journal|last1=Dolmans|first1=Ruben A. V.|last2=Boel|first2=C. H. Edwin|last3=Lacle|first3=Miangela M.|last4=Kusters|first4=Johannes G.|title=Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections|journal=Clinical Microbiology Reviews|volume=30|issue=2|year=2017|pages=529–555|issn=0893-8512|doi=10.1128/CMR.00033-16}}</ref><ref name="pmid18159328">{{cite journal |vauthors=Conly JM, Johnston BL |title=Rare but not so rare: The evolving spectrum of Whipple's disease |journal=Can J Infect Dis |volume=12 |issue=3 |pages=133–5 |year=2001 |pmid=18159328 |pmc=2094813 |doi= |url=}}</ref><ref name="FenollarLagier2014">{{cite journal|last1=Fenollar|first1=Florence|last2=Lagier|first2=Jean-Christophe|last3=Raoult|first3=Didier|title=Tropheryma whipplei and Whipple's disease|journal=Journal of Infection|volume=69|issue=2|year=2014|pages=103–112|issn=01634453|doi=10.1016/j.jinf.2014.05.008}}</ref><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><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 presence of [[eye]] findings namely oculomasticatory, or | |||
*The presence of [[eye]] findings namely oculomasticatory myorhythmia, or oculofacial-skeletal myorhythmia are pathognomic. | |||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
* | * Patients with Whipple's disease usually appear tired and weak. | ||
* [[Cachexia]] | |||
===Vital Signs=== | ===Vital Signs=== | ||
*Low-grade intermittent [[fever]] | |||
*Low-grade intermittent fever | *[[Tachycardia]] | ||
* | * [[Hypotension]] | ||
* [[Tachypnea]] | |||
===Skin=== | ===Skin=== | ||
*Hyperpigmentation | *[[Pallor]] | ||
* | *[[Hyperpigmentation]] in sun exposed areas | ||
*[[Cyanosis]] | |||
*[[Skin nodules]] | |||
===HEENT=== | ===HEENT=== | ||
* [[Nystagmus]] | * [[Nystagmus]] | ||
* | * [[Papilledema]] | ||
* | * Abnormal [[eye movements]] | ||
* Oculomasticatory myorhythmia (pathognomonic) | |||
* Oculofacial-skeletal myorhythmia (pathognomonic) | |||
===Neck=== | ===Neck=== | ||
*[[Lymphadenopathy]] | *[[Lymphadenopathy]] (common in peripheral [[lymph nodes]]) | ||
===Lungs=== | ===Lungs=== | ||
In patients who develop pleural effusion | *In patients who develop [[pleural effusion]], may have: | ||
* | **Asymmetrical [[chest expansion]] | ||
* | **[[Lungs]] are hyperresonant | ||
*Distant breath sounds | **Distant [[breath sounds]] | ||
*Reduced [[tactile fremitus]] | **Reduced [[tactile fremitus]] | ||
===Heart=== | ===Heart=== | ||
*[[ | *[[Systolic murmur]] | ||
*[[Pericardial friction rub]] | |||
*[[Pericardial]] knock | |||
*Wide split of [[S2]] | |||
*Elevation of [[jugular venous pulse]] | |||
===Abdomen=== | ===Abdomen=== | ||
*[[Abdominal distention | *[[Abdominal distention]] | ||
*[[ | *[[Hepatosplenomegaly]] | ||
*[[Jaundice]] | |||
*[[Edema]] | |||
*[[Ascites]] | |||
===Neuromuscular=== | ===Neuromuscular=== | ||
*May be asymptomatic | *May be [[asymptomatic]] | ||
*Altered level of [[consciousness]] | |||
*Altered level of consciousness | *[[Seizure]] | ||
*Seizure | *[[Myoclonus]] | ||
* Myoclonus | *[[Ataxia]] | ||
* Ataxia | *Supranuclear ophthalmoplegia | ||
*[[Dementia]] | |||
*[[Hemiparesis]] | |||
===Extremities=== | ===Extremities=== | ||
* | *[[Arthritis]] | ||
*Joint deformity | *[[Joint]] deformity (extremely rare) | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
| |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Medicine]] | |||
[[Category:Gastroenterology]] | |||
[[Category:Infectious disease]] | |||
[[Category:Up-To-Date]] | |||
Latest revision as of 00:44, 30 July 2020
|
Whipple's disease Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Whipple's disease physical examination On the Web |
|
American Roentgen Ray Society Images of Whipple's disease physical examination |
|
Risk calculators and risk factors for Whipple's disease physical examination |
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 usually appear weak. Physical examination of patients with Whipple's disease is usually remarkable for weight loss and signs of vitamin deficiency. Further physical findings depend on the systems involved in the disease. Abnormal eye movements including oculomasticatory myorhythmia, or oculofacial-skeletal myorhythmia are pathognomonic for the Whipple's disease.
Physical Examination
- Physical examination of patients with Whipple's disease is usually remarkable for generalized weakness secondary to weight loss.[1][2][3][4][5][6][7][8][9][10][11][12]
- The presence of eye findings namely oculomasticatory myorhythmia, or oculofacial-skeletal myorhythmia are pathognomic.
Appearance of the Patient
- Patients with Whipple's disease usually appear tired and weak.
- Cachexia
Vital Signs
- Low-grade intermittent fever
- Tachycardia
- Hypotension
- Tachypnea
Skin
- Pallor
- Hyperpigmentation in sun exposed areas
- Cyanosis
- Skin nodules
HEENT
- Nystagmus
- Papilledema
- Abnormal eye movements
- Oculomasticatory myorhythmia (pathognomonic)
- Oculofacial-skeletal myorhythmia (pathognomonic)
Neck
- Lymphadenopathy (common in peripheral lymph nodes)
Lungs
- In patients who develop pleural effusion, may have:
- Asymmetrical chest expansion
- Lungs are hyperresonant
- Distant breath sounds
- Reduced tactile fremitus
Heart
- Systolic murmur
- Pericardial friction rub
- Pericardial knock
- Wide split of S2
- Elevation of jugular venous pulse
Abdomen
Neuromuscular
- May be asymptomatic
- Altered level of consciousness
- Seizure
- Myoclonus
- Ataxia
- Supranuclear ophthalmoplegia
- Dementia
- Hemiparesis
Extremities
References
- ↑ 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.
- ↑ Fenollar F, Puéchal X, Raoult D (2007). "Whipple's disease". N Engl J Med. 356 (1): 55–66. doi:10.1056/NEJMra062477. PMID 17202456.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.