Whipple's disease natural history, complications and prognosis: Difference between revisions

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===Natural History===
===Natural History===
Tropheryma whipplei infection has different clinical manifestation and natural history. It could cause acute infection, localized infection and the classic Whipple's disease. Each of these manifestations has its own progression.  
Tropheryma whipplei infection has different clinical manifestations. It could cause acute infection, localized infection and the classic Whipple's disease. Each of them has its own progression and natural history.  


==== Acute infection ====
==== Acute infection ====
* Tropheryma whipplei causes acute infections, including:<ref name="RaoultFenollar2010">{{cite journal|last1=Raoult|first1=Didier|last2=Fenollar|first2=Florence|last3=Rolain|first3=Jean-Marc|last4=Minodier|first4=Philippe|last5=Bosdure|first5=Emmanuelle|last6=Li|first6=Wenjun|last7=Garnier|first7=Jean-Marc|last8=Richet|first8=Hervé|title=Tropheryma whipplei in Children with Gastroenteritis|journal=Emerging Infectious Diseases|volume=16|issue=5|year=2010|pages=776–782|issn=1080-6040|doi=10.3201/eid1605.091801}}</ref>
* Tropheryma whipplei causes acute infections, including:<ref name="RaoultFenollar2010">{{cite journal|last1=Raoult|first1=Didier|last2=Fenollar|first2=Florence|last3=Rolain|first3=Jean-Marc|last4=Minodier|first4=Philippe|last5=Bosdure|first5=Emmanuelle|last6=Li|first6=Wenjun|last7=Garnier|first7=Jean-Marc|last8=Richet|first8=Hervé|title=Tropheryma whipplei in Children with Gastroenteritis|journal=Emerging Infectious Diseases|volume=16|issue=5|year=2010|pages=776–782|issn=1080-6040|doi=10.3201/eid1605.091801}}</ref>
** Gastroenteritis: Patients have watery diarrhea and colicky abdominal pain.
** Gastroenteritis: Patients have watery diarrhea and colicky abdominal pain.
** Pneumonia
** Pneumonia:
** Bacteremia
** Bacteremia:


==== Classic Whipple's disease ====
==== Classic Whipple's disease ====
Patients who developed the classic Whipple's disease have different natural history
Patients who developed the classic Whipple's disease, usually have 3 clinical phases:
*Patient with classic Whipple's disease in the early phase has nonspecific symptoms including [[fever]] and [[arthralgia]] that could last for years.<ref name="BaiMazure2004">{{cite journal|last1=Bai|first1=J|last2=Mazure|first2=R|last3=Vazquez|first3=H|last4=Niveloni|first4=S|last5=Smecuol|first5=E|last6=Pedreira|first6=S|last7=Maurino|first7=E|title=Whipple’s disease|journal=Clinical Gastroenterology and Hepatology|volume=2|issue=10|year=2004|pages=849–860|issn=15423565|doi=10.1016/S1542-3565(04)00387-8}}</ref>
*In the early phase, patients have nonspecific symptoms including [[fever]] and [[arthralgia]] that could last for years.<ref name="BaiMazure2004">{{cite journal|last1=Bai|first1=J|last2=Mazure|first2=R|last3=Vazquez|first3=H|last4=Niveloni|first4=S|last5=Smecuol|first5=E|last6=Pedreira|first6=S|last7=Maurino|first7=E|title=Whipple’s disease|journal=Clinical Gastroenterology and Hepatology|volume=2|issue=10|year=2004|pages=849–860|issn=15423565|doi=10.1016/S1542-3565(04)00387-8}}</ref>
*In the middle phase, patients develop [[gastrointestinal]] symptoms including [[diarrhea]], [[abdominal pain]] and [[weight loss]].<ref name="Puéchal2013">{{cite journal|last1=Puéchal|first1=Xavier|title=Whipple's disease|journal=Annals of the Rheumatic Diseases|volume=72|issue=6|year=2013|pages=797–803|issn=0003-4967|doi=10.1136/annrheumdis-2012-202684}}</ref>
*In the middle phase, patients develop [[gastrointestinal]] symptoms including [[diarrhea]], [[abdominal pain]] and [[weight loss]].<ref name="Puéchal2013">{{cite journal|last1=Puéchal|first1=Xavier|title=Whipple's disease|journal=Annals of the Rheumatic Diseases|volume=72|issue=6|year=2013|pages=797–803|issn=0003-4967|doi=10.1136/annrheumdis-2012-202684}}</ref>
*In the late phase, other organs might be involved. [[Neurological disease|Neurologic]] symptoms including progressive [[dementia]], [[personality changes]] and [[seizures]] might happen. [[Eyes]], [[heart]], [[lung]], [[liver]], and [[skin]] can be involved in this phase.<ref name="FlemingWiesner1988">{{cite journal|last1=Fleming|first1=Jon L.|last2=Wiesner|first2=Russell H.|last3=Shorter|first3=Roy G.|title=Whipple's Disease: Clinical, Biochemical, and Histopathologic Features and Assessment of Treatment in 29 Patients|journal=Mayo Clinic Proceedings|volume=63|issue=6|year=1988|pages=539–551|issn=00256196|doi=10.1016/S0025-6196(12)64884-8}}</ref>
*In the late phase, other organs might be involved. [[Neurological disease|Neurologic]] symptoms including progressive [[dementia]], [[personality changes]] and [[seizures]] might happen. [[Eyes]], [[heart]], [[lung]], [[liver]], and [[skin]] can be involved in this phase.<ref name="FlemingWiesner1988">{{cite journal|last1=Fleming|first1=Jon L.|last2=Wiesner|first2=Russell H.|last3=Shorter|first3=Roy G.|title=Whipple's Disease: Clinical, Biochemical, and Histopathologic Features and Assessment of Treatment in 29 Patients|journal=Mayo Clinic Proceedings|volume=63|issue=6|year=1988|pages=539–551|issn=00256196|doi=10.1016/S0025-6196(12)64884-8}}</ref>
**


==== Localized infection ====
==== Localized infection ====
Patients might present with localized infection instead of systemic involvement after being infected by [[Tropheryma whipplei]].
*  
*  


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===Prognosis===
===Prognosis===
*Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
*Prognosis is generally very poor, if left untreated.
*Depending on the extent of the [tumor/disease progression/etc.] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.
*The presence of neurologic symptoms is associated with a particularly poor prognosis among patients with Whipple's disease.
*The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy].
*[Subtype of disease/malignancy] is associated with the most favorable prognosis.
*The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.


==References==
==References==

Revision as of 03:21, 2 November 2017

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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]

Overview

If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

Natural History, Complications, and Prognosis

Natural History

Tropheryma whipplei infection has different clinical manifestations. It could cause acute infection, localized infection and the classic Whipple's disease. Each of them has its own progression and natural history.

Acute infection

  • Tropheryma whipplei causes acute infections, including:[1]
    • Gastroenteritis: Patients have watery diarrhea and colicky abdominal pain.
    • Pneumonia:
    • Bacteremia:

Classic Whipple's disease

Patients who developed the classic Whipple's disease, usually have 3 clinical phases:

Localized infection

Patients might present with localized infection instead of systemic involvement after being infected by Tropheryma whipplei.

Complications

  • Common complications of Whipple's disease include:
    • Cardiac complications
      • Adhesive pericarditis
      • Myocardial fibrosis
    • Neurologic complications
      • Progressive dementia
      • Cerebellar ataxia
      • Personality changes
      • Hemiparesis
      • Seizure
      • Wernicke’s encephalopathy
      • Hypothalamic involvement
      • Supranuclear ophthalmoplegia

Prognosis

  • Prognosis is generally very poor, if left untreated.
  • The presence of neurologic symptoms is associated with a particularly poor prognosis among patients with Whipple's disease.

References

  1. ↑ Raoult, Didier; Fenollar, Florence; Rolain, Jean-Marc; Minodier, Philippe; Bosdure, Emmanuelle; Li, Wenjun; Garnier, Jean-Marc; Richet, Hervé (2010). "Tropheryma whipplei in Children with Gastroenteritis". Emerging Infectious Diseases. 16 (5): 776–782. doi:10.3201/eid1605.091801. ISSN 1080-6040.
  2. ↑ Bai, J; Mazure, R; Vazquez, H; Niveloni, S; Smecuol, E; Pedreira, S; Maurino, E (2004). "Whipple's disease". Clinical Gastroenterology and Hepatology. 2 (10): 849–860. doi:10.1016/S1542-3565(04)00387-8. ISSN 1542-3565.
  3. ↑ Puéchal, Xavier (2013). "Whipple's disease". Annals of the Rheumatic Diseases. 72 (6): 797–803. doi:10.1136/annrheumdis-2012-202684. ISSN 0003-4967.
  4. ↑ Fleming, Jon L.; Wiesner, Russell H.; Shorter, Roy G. (1988). "Whipple's Disease: Clinical, Biochemical, and Histopathologic Features and Assessment of Treatment in 29 Patients". Mayo Clinic Proceedings. 63 (6): 539–551. doi:10.1016/S0025-6196(12)64884-8. ISSN 0025-6196.

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