Whipple's disease physical examination: Difference between revisions
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===Vital Signs=== | ===Vital Signs=== | ||
*Low-grade intermittent [[fever]] | *Low-grade intermittent [[fever]] | ||
*[[Tachycardia]] | |||
* [[Hypotension]] | * [[Hypotension]] | ||
* [[Tachypnea]] | |||
===Skin=== | ===Skin=== | ||
*[[Pallor]] | *[[Pallor]] | ||
*[[Hyperpigmentation]] | *[[Hyperpigmentation]] in sun exposed areas | ||
*Skin nodules | *[[Cyanosis]] | ||
*[[Skin nodules]] | |||
===HEENT=== | ===HEENT=== | ||
* [[Nystagmus]] | * [[Nystagmus]] | ||
* [[Papilledema]] | |||
* Abnormal extra-ocular movements | * Abnormal extra-ocular movements | ||
* Oculomasticatory (pathognomic) | * Oculomasticatory (pathognomic) | ||
| Line 34: | Line 38: | ||
===Lungs=== | ===Lungs=== | ||
*In patients who develop [[pleural effusion]], may have: | *In patients who develop [[pleural effusion]], may have: | ||
**Asymmetrical chest expansion | **Asymmetrical [[chest expansion]] | ||
**Lungs are | **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]] | *[[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 (extremely rare) | *Joint deformity (extremely rare) | ||
Revision as of 17:07, 12 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Bhagyashree Deshmankar M.B.B.S.[2]; Sadaf Sharfaei M.D.[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 joint pain. Further physical findings depend on the systems involved in the 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, or oculofacialskeletal, 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 extra-ocular movements
- Oculomasticatory (pathognomic)
- Oculofacialskeletal (pathognomic)
- Myorhythmia (pathognomic)
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
- Arthritis
- Joint deformity (extremely rare)
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.