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*[[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>
*[[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 bacteria live in soil and wastewater. Farmers and everyone who has any contact with contaminated soil and water are at high risk of the infection.  
* 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.  


*It is transmitted through oro-oral and feco-oral routes. The poor sanitation is associated with 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>  
*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>  


*It is believed that human being is the only reservoir for this bacteria.<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>
*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>


*It invades intestines primarily and then every other organ including the heart, CNS, joints, lymph nodes, skin, lungs and the eyes.
*It invades [[Intestine|intestines]] primarily and then every other organ including the heart, CNS, joints, lymph nodes, skin, lungs and the eyes.


* Tropheryma whipplei infection has four different 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>
* [[Tropheryma whipplei]] infection has four different 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>
* 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>
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==Microscopic Pathology==
==Microscopic Pathology==
*On microscopic histopathological analysis, PAS-positive 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>
*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>


The images show the characteristic feature of Whipple's disease; foamy macrophages are present in the lamina propria.
The images show the characteristic feature of Whipple's disease; foamy [[Macrophage|macrophages]] are present in the [[lamina propria]].


<gallery align="left">
<gallery align="left">
Image: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 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>
Image: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 - 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>
Image: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 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>
Image: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>
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>
</gallery>


Revision as of 20:49, 18 October 2017

Whipple's disease Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

[Pathogen name] is usually transmitted via the [transmission route] route to the human host. 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

Pathogenesis

  • 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.
  • It is transmitted through oro-oral and feco-oral routes. The poor sanitation is associated with T. whipplei infection. [3]
  • It is believed that human being is the only reservoir for this bacterium.[4]
  • It invades intestines primarily and then every other organ including the heart, CNS, joints, lymph nodes, skin, lungs and the eyes.
  • Tropheryma whipplei infection has four different manifestations: acute infection, the classic Whipple’s disease, asymptomatic carrier state, and localized chronic infection.[5] [6]
  • It is believed that host immunologic response to the microorganism plays an important role on the clinical manifestation of the disease.[7]

Immunologic response

Genetics

  • [Disease name] is transmitted in [mode of genetic transmission] pattern.
  • Genes involved in the pathogenesis of [disease name] include [gene1], [gene2], and [gene3].
  • The development of [disease name] is the result of multiple genetic mutations.

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

The images show the characteristic feature of Whipple's disease; foamy macrophages are present in the lamina propria.

  • Low magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)[9]
    Low magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)[9]
  • Intermediate magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)[10]
    Intermediate magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)[10]
  • High magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)[11]
    High magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)[11]
  • Very high magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)[12]
    Very high magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)[12]

References

  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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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. ↑ Marth, Thomas (2009). "New Insights into Whipple's Disease – A Rare Intestinal Inflammatory Disorder". Digestive Diseases. 27 (4): 494–501. doi:10.1159/000233288. ISSN 1421-9875.
  6. ↑ Street, Sara; Donoghue, Helen D; Neild, GH (1999). "Tropheryma whippelii DNA in saliva of healthy people". The Lancet. 354 (9185): 1178–1179. doi:10.1016/S0140-6736(99)03065-2. ISSN 0140-6736.
  7. ↑ Marth T, Strober W (1996). "Whipple's disease". Semin. Gastrointest. Dis. 7 (1): 41–8. PMID 8903578.
  8. ↑ Schneider, Thomas; Moos, Verena; Loddenkemper, Christoph; Marth, Thomas; Fenollar, Florence; Raoult, Didier (2008). "Whipple's disease: new aspects of pathogenesis and treatment". The Lancet Infectious Diseases. 8 (3): 179–190. doi:10.1016/S1473-3099(08)70042-2. ISSN 1473-3099.
  9. ↑ CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15357443
  10. ↑ CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15357450
  11. ↑ CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15357481
  12. ↑ CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15357462

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