Whipple's disease natural history, complications and prognosis: Difference between revisions
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*[[Tropheryma whipplei]] causes acute infections, including: | *[[Tropheryma whipplei]] causes acute infections, including: | ||
**[[Gastroenteritis]]: Patients have watery [[diarrhea]], [[steatorrhea]], and colicky [[abdominal pain]].<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]], [[steatorrhea]], and colicky [[abdominal pain]].<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> | ||
**Pneumonia: Tropheryma whipplei causes pneumonia in HIV patients.<ref name="LozuponeCota-Gomez2013">{{cite journal|last1=Lozupone|first1=Catherine|last2=Cota-Gomez|first2=Adela|last3=Palmer|first3=Brent E.|last4=Linderman|first4=Derek J.|last5=Charlson|first5=Emily S.|last6=Sodergren|first6=Erica|last7=Mitreva|first7=Makedonka|last8=Abubucker|first8=Sahar|last9=Martin|first9=John|last10=Yao|first10=Guohui|last11=Campbell|first11=Thomas B.|last12=Flores|first12=Sonia C.|last13=Ackerman|first13=Gail|last14=Stombaugh|first14=Jesse|last15=Ursell|first15=Luke|last16=Beck|first16=James M.|last17=Curtis|first17=Jeffrey L.|last18=Young|first18=Vincent B.|last19=Lynch|first19=Susan V.|last20=Huang|first20=Laurence|last21=Weinstock|first21=George M.|last22=Knox|first22=Kenneth S.|last23=Twigg|first23=Homer|last24=Morris|first24=Alison|last25=Ghedin|first25=Elodie|last26=Bushman|first26=Frederic D.|last27=Collman|first27=Ronald G.|last28=Knight|first28=Rob|last29=Fontenot|first29=Andrew P.|title=Widespread Colonization of the Lung byTropheryma whippleiin HIV Infection|journal=American Journal of Respiratory and Critical Care Medicine|volume=187|issue=10|year=2013|pages=1110–1117|issn=1073-449X|doi=10.1164/rccm.201211-2145OC}}</ref> | **[[Pneumonia]]: [[Tropheryma whipplei]] causes [[pneumonia]] in [[HIV]] patients.<ref name="LozuponeCota-Gomez2013">{{cite journal|last1=Lozupone|first1=Catherine|last2=Cota-Gomez|first2=Adela|last3=Palmer|first3=Brent E.|last4=Linderman|first4=Derek J.|last5=Charlson|first5=Emily S.|last6=Sodergren|first6=Erica|last7=Mitreva|first7=Makedonka|last8=Abubucker|first8=Sahar|last9=Martin|first9=John|last10=Yao|first10=Guohui|last11=Campbell|first11=Thomas B.|last12=Flores|first12=Sonia C.|last13=Ackerman|first13=Gail|last14=Stombaugh|first14=Jesse|last15=Ursell|first15=Luke|last16=Beck|first16=James M.|last17=Curtis|first17=Jeffrey L.|last18=Young|first18=Vincent B.|last19=Lynch|first19=Susan V.|last20=Huang|first20=Laurence|last21=Weinstock|first21=George M.|last22=Knox|first22=Kenneth S.|last23=Twigg|first23=Homer|last24=Morris|first24=Alison|last25=Ghedin|first25=Elodie|last26=Bushman|first26=Frederic D.|last27=Collman|first27=Ronald G.|last28=Knight|first28=Rob|last29=Fontenot|first29=Andrew P.|title=Widespread Colonization of the Lung byTropheryma whippleiin HIV Infection|journal=American Journal of Respiratory and Critical Care Medicine|volume=187|issue=10|year=2013|pages=1110–1117|issn=1073-449X|doi=10.1164/rccm.201211-2145OC}}</ref> | ||
**Bacteremia: Tropheryma whipplei infection could cause self-limiting bacteremia.<ref name="FenollarMediannikov2010">{{cite journal|last1=Fenollar|first1=Florence|last2=Mediannikov|first2=Oleg|last3=Socolovschi|first3=Cristina|last4=Bassene|first4=Hubert|last5=Diatta|first5=Georges|last6=Richet|first6=Hervé|last7=Tall|first7=Adama|last8=Sokhna|first8=Cheikh|last9=Trape|first9=Jean‐François|last10=Raoult|first10=Didier|title=Tropheryma whippleiBacteremia during Fever in Rural West Africa|journal=Clinical Infectious Diseases|volume=51|issue=5|year=2010|pages=515–521|issn=1058-4838|doi=10.1086/655677}}</ref> | **[[Bacteremia]]: [[Tropheryma whipplei]] [[infection]] could cause self-limiting [[bacteremia]].<ref name="FenollarMediannikov2010">{{cite journal|last1=Fenollar|first1=Florence|last2=Mediannikov|first2=Oleg|last3=Socolovschi|first3=Cristina|last4=Bassene|first4=Hubert|last5=Diatta|first5=Georges|last6=Richet|first6=Hervé|last7=Tall|first7=Adama|last8=Sokhna|first8=Cheikh|last9=Trape|first9=Jean‐François|last10=Raoult|first10=Didier|title=Tropheryma whippleiBacteremia during Fever in Rural West Africa|journal=Clinical Infectious Diseases|volume=51|issue=5|year=2010|pages=515–521|issn=1058-4838|doi=10.1086/655677}}</ref> | ||
==== Classic Whipple's disease ==== | ==== Classic Whipple's disease ==== | ||
Patients who developed the classic Whipple's disease, usually have 3 clinical phases: | Patients who developed the classic Whipple's disease, usually have 3 clinical phases: | ||
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==== Localized infection ==== | ==== Localized infection ==== | ||
Patients might present with localized infection instead of systemic involvement after being infected by [[Tropheryma whipplei]]. | Patients might present with localized infection instead of systemic involvement after being infected by [[Tropheryma whipplei]]. | ||
*Endocarditis: Patients might develop blood culture-negative endocarditis. Since it is hard to diagnose Tropheryma whipplei infection without the systemic symptoms, if left untreated, it could be lethal.<ref name="GeissdorferMoos2011">{{cite journal|last1=Geissdorfer|first1=W.|last2=Moos|first2=V.|last3=Moter|first3=A.|last4=Loddenkemper|first4=C.|last5=Jansen|first5=A.|last6=Tandler|first6=R.|last7=Morguet|first7=A. J.|last8=Fenollar|first8=F.|last9=Raoult|first9=D.|last10=Bogdan|first10=C.|last11=Schneider|first11=T.|title=High Frequency of Tropheryma whipplei in Culture-Negative Endocarditis|journal=Journal of Clinical Microbiology|volume=50|issue=2|year=2011|pages=216–222|issn=0095-1137|doi=10.1128/JCM.05531-11}}</ref> | *[[Endocarditis]]: Patients might develop blood [[culture-negative endocarditis]]. Since it is hard to diagnose [[Tropheryma whipplei]] infection without the systemic symptoms, if left untreated, it could be lethal.<ref name="GeissdorferMoos2011">{{cite journal|last1=Geissdorfer|first1=W.|last2=Moos|first2=V.|last3=Moter|first3=A.|last4=Loddenkemper|first4=C.|last5=Jansen|first5=A.|last6=Tandler|first6=R.|last7=Morguet|first7=A. J.|last8=Fenollar|first8=F.|last9=Raoult|first9=D.|last10=Bogdan|first10=C.|last11=Schneider|first11=T.|title=High Frequency of Tropheryma whipplei in Culture-Negative Endocarditis|journal=Journal of Clinical Microbiology|volume=50|issue=2|year=2011|pages=216–222|issn=0095-1137|doi=10.1128/JCM.05531-11}}</ref> | ||
*Encephalitis: Ataxia and dementia are common. Empirical antibiotic therapy might be considered for rapid resolution.<ref name="FenollarNicoli2011">{{cite journal|last1=Fenollar|first1=Florence|last2=Nicoli|first2=François|last3=Paquet|first3=Claire|last4=Lepidi|first4=Hubert|last5=Cozzone|first5=Patrick|last6=Antoine|first6=Jean-Christophe|last7=Pouget|first7=Jean|last8=Raoult|first8=Didier|title=Progressive dementia associated with ataxia or obesity in patients with Tropheryma whipplei encephalitis|journal=BMC Infectious Diseases|volume=11|issue=1|year=2011|issn=1471-2334|doi=10.1186/1471-2334-11-171}}</ref> | *[[Encephalitis]]: [[Ataxia]] and [[dementia]] are common. Empirical [[antibiotic]] therapy might be considered for rapid resolution.<ref name="FenollarNicoli2011">{{cite journal|last1=Fenollar|first1=Florence|last2=Nicoli|first2=François|last3=Paquet|first3=Claire|last4=Lepidi|first4=Hubert|last5=Cozzone|first5=Patrick|last6=Antoine|first6=Jean-Christophe|last7=Pouget|first7=Jean|last8=Raoult|first8=Didier|title=Progressive dementia associated with ataxia or obesity in patients with Tropheryma whipplei encephalitis|journal=BMC Infectious Diseases|volume=11|issue=1|year=2011|issn=1471-2334|doi=10.1186/1471-2334-11-171}}</ref> | ||
*Pulmonary involvement: Patients might present with interstitial lung disease, dry cough and shortness of breath.<ref name="UrbanskiRivereau2012">{{cite journal|last1=Urbanski|first1=Geoffrey|last2=Rivereau|first2=Philippe|last3=Artru|first3=Laure|last4=Fenollar|first4=Florence|last5=Raoult|first5=Didier|last6=Puéchal|first6=Xavier|title=Whipple Disease Revealed by Lung Involvement|journal=Chest|volume=141|issue=6|year=2012|pages=1595–1598|issn=00123692|doi=10.1378/chest.11-1812}}</ref> | *[[Pulmonary]] involvement: Patients might present with [[interstitial lung disease]], dry [[cough]] and [[shortness of breath]].<ref name="UrbanskiRivereau2012">{{cite journal|last1=Urbanski|first1=Geoffrey|last2=Rivereau|first2=Philippe|last3=Artru|first3=Laure|last4=Fenollar|first4=Florence|last5=Raoult|first5=Didier|last6=Puéchal|first6=Xavier|title=Whipple Disease Revealed by Lung Involvement|journal=Chest|volume=141|issue=6|year=2012|pages=1595–1598|issn=00123692|doi=10.1378/chest.11-1812}}</ref> | ||
*Osteoarticular involvement: Isolated arthritis and | *Osteoarticular involvement: Isolated [[arthritis]] and [[spondylodiscitis]] are happened without systemic manifestations.<ref name="Bruhlmann2000">{{cite journal|last1=Bruhlmann|first1=P.|title=Diagnosis and therapy monitoring of Whipple's arthritis by polymerase chain reaction|journal=Rheumatology|volume=39|issue=12|year=2000|pages=1427–1428|issn=14602172|doi=10.1093/rheumatology/39.12.1427}}</ref> | ||
*Eyes involvement: Patients might present with isolated uveitis and PCR of aqueous humor is used to establish the diagnosis.<ref name="BauerfeindKoelz1999">{{cite journal|last1=Bauerfeind|first1=Peter|last2=Koelz|first2=Hans-Rudolf|last3=Altwegg|first3=Martin|title=PCR for Tropheryma whippelii|journal=The Lancet|volume=354|issue=9188|year=1999|pages=1476–1477|issn=01406736|doi=10.1016/S0140-6736(05)77620-0}}</ref> | *[[Eyes]] involvement: Patients might present with isolated [[uveitis]] and [[PCR]] of [[Aqueous humour|aqueous humor]] is used to establish the diagnosis.<ref name="BauerfeindKoelz1999">{{cite journal|last1=Bauerfeind|first1=Peter|last2=Koelz|first2=Hans-Rudolf|last3=Altwegg|first3=Martin|title=PCR for Tropheryma whippelii|journal=The Lancet|volume=354|issue=9188|year=1999|pages=1476–1477|issn=01406736|doi=10.1016/S0140-6736(05)77620-0}}</ref> | ||
===Complications=== | ===Complications=== | ||
Common complications of Whipple's disease include:<ref name="FenollarPuéchal2007">{{cite journal|last1=Fenollar|first1=Florence|last2=Puéchal|first2=Xavier|last3=Raoult|first3=Didier|title=Whipple's Disease|journal=New England Journal of Medicine|volume=356|issue=1|year=2007|pages=55–66|issn=0028-4793|doi=10.1056/NEJMra062477}}</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="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="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> | Common complications of Whipple's disease include:<ref name="FenollarPuéchal2007">{{cite journal|last1=Fenollar|first1=Florence|last2=Puéchal|first2=Xavier|last3=Raoult|first3=Didier|title=Whipple's Disease|journal=New England Journal of Medicine|volume=356|issue=1|year=2007|pages=55–66|issn=0028-4793|doi=10.1056/NEJMra062477}}</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="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="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> | ||
*'''Cardiac complications''' | *'''Cardiac complications''' | ||
**Adhesive pericarditis | **Adhesive [[pericarditis]] | ||
**Myocardial fibrosis | **[[Myocardial]] [[fibrosis]] | ||
**Congestive heart failure | **[[Congestive heart failure]] | ||
**Valvular heart disease | **[[Valvular heart disease]] | ||
**Acute ischemic stroke | **[[Acute ischemic stroke]] | ||
**Embolic events | **[[Embolism|Embolic]] events | ||
*'''Neurologic complications''' | *'''Neurologic complications''' | ||
**Progressive dementia | **Progressive [[dementia]] | ||
**Cerebellar ataxia | **[[Cerebellar ataxias|Cerebellar ataxia]] | ||
**Personality changes | **[[Personality changes]] | ||
**Hemiparesis | **[[Hemiparesis]] | ||
**Seizure | **[[Seizure]] | ||
**Wernicke’s encephalopathy | **[[Wernicke's encephalopathy|Wernicke’s encephalopathy]] | ||
**Hypothalamic involvement | **[[Hypothalamic|Hypothalamic involvement]] | ||
**Supranuclear ophthalmoplegia | **[[Supranuclear ophthalmoplegia]] | ||
*'''Pulmonary complications''' | *'''Pulmonary complications''' | ||
**Pulmonary hypertension | **[[Pulmonary hypertension]] | ||
*'''Osteoarticular complications''' | *'''Osteoarticular complications''' | ||
**Destructive arthritis | **Destructive [[arthritis]] | ||
**Joint deformity | **[[Joint]] deformity | ||
===Prognosis=== | ===Prognosis=== | ||
*Prognosis is generally very poor, if left untreated.<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> | *Prognosis is generally very poor, if left untreated.<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> | ||
*The prognosis of Whipple's disease is good if diagnosed properly and long-term treatment started early.<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> | *The prognosis of Whipple's disease is good if diagnosed properly and long-term treatment started early.<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> | ||
*The presence of neurologic symptoms is associated with a particularly poor prognosis among patients with Whipple's disease.<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> | *The presence of [[neurologic]] symptoms is associated with a particularly poor prognosis among patients with Whipple's disease.<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> | ||
*The risk of relapse is approximately 40%, if treatment is not completed.<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> | *The risk of [[relapse]] is approximately 40%, if treatment is not completed.<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> | ||
*Relapse of Whipple's disease might occur up to 30 years after treatment and it is commonly responsible for morbidity and mortality.<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> | *[[Relapse]] of Whipple's disease might occur up to 30 years after treatment and it is commonly responsible for [[Morbidity & Mortality|morbidity and mortality]].<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> | ||
==References== | ==References== | ||
Revision as of 19:33, 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
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:
- Gastroenteritis: Patients have watery diarrhea, steatorrhea, and colicky abdominal pain.[1]
- Pneumonia: Tropheryma whipplei causes pneumonia in HIV patients.[2]
- Bacteremia: Tropheryma whipplei infection could cause self-limiting bacteremia.[3]
Classic Whipple's disease
Patients who developed the classic Whipple's disease, usually have 3 clinical phases:
- In the early phase, patients have nonspecific symptoms including fever and arthralgia that could last for years.[4]
- In the middle phase, patients develop gastrointestinal symptoms including diarrhea, abdominal pain and weight loss.[5]
- In the late phase, other organs might be involved. Neurologic symptoms including progressive dementia, personality changes and seizures might happen. Eyes, heart, lung, liver, and skin can be involved in this phase.[6]
Localized infection
Patients might present with localized infection instead of systemic involvement after being infected by Tropheryma whipplei.
- Endocarditis: Patients might develop blood culture-negative endocarditis. Since it is hard to diagnose Tropheryma whipplei infection without the systemic symptoms, if left untreated, it could be lethal.[7]
- Encephalitis: Ataxia and dementia are common. Empirical antibiotic therapy might be considered for rapid resolution.[8]
- Pulmonary involvement: Patients might present with interstitial lung disease, dry cough and shortness of breath.[9]
- Osteoarticular involvement: Isolated arthritis and spondylodiscitis are happened without systemic manifestations.[10]
- Eyes involvement: Patients might present with isolated uveitis and PCR of aqueous humor is used to establish the diagnosis.[11]
Complications
Common complications of Whipple's disease include:[12][13][14][15][16]
- Cardiac complications
- Neurologic complications
- Pulmonary complications
Prognosis
- Prognosis is generally very poor, if left untreated.[13]
- The prognosis of Whipple's disease is good if diagnosed properly and long-term treatment started early.[14]
- The presence of neurologic symptoms is associated with a particularly poor prognosis among patients with Whipple's disease.[15]
- The risk of relapse is approximately 40%, if treatment is not completed.[16]
- Relapse of Whipple's disease might occur up to 30 years after treatment and it is commonly responsible for morbidity and mortality.[16]
References
- ↑ 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.
- ↑ Lozupone, Catherine; Cota-Gomez, Adela; Palmer, Brent E.; Linderman, Derek J.; Charlson, Emily S.; Sodergren, Erica; Mitreva, Makedonka; Abubucker, Sahar; Martin, John; Yao, Guohui; Campbell, Thomas B.; Flores, Sonia C.; Ackerman, Gail; Stombaugh, Jesse; Ursell, Luke; Beck, James M.; Curtis, Jeffrey L.; Young, Vincent B.; Lynch, Susan V.; Huang, Laurence; Weinstock, George M.; Knox, Kenneth S.; Twigg, Homer; Morris, Alison; Ghedin, Elodie; Bushman, Frederic D.; Collman, Ronald G.; Knight, Rob; Fontenot, Andrew P. (2013). "Widespread Colonization of the Lung byTropheryma whippleiin HIV Infection". American Journal of Respiratory and Critical Care Medicine. 187 (10): 1110–1117. doi:10.1164/rccm.201211-2145OC. ISSN 1073-449X.
- ↑ Fenollar, Florence; Mediannikov, Oleg; Socolovschi, Cristina; Bassene, Hubert; Diatta, Georges; Richet, Hervé; Tall, Adama; Sokhna, Cheikh; Trape, Jean‐François; Raoult, Didier (2010). "Tropheryma whippleiBacteremia during Fever in Rural West Africa". Clinical Infectious Diseases. 51 (5): 515–521. doi:10.1086/655677. ISSN 1058-4838.
- ↑ 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.
- ↑ Puéchal, Xavier (2013). "Whipple's disease". Annals of the Rheumatic Diseases. 72 (6): 797–803. doi:10.1136/annrheumdis-2012-202684. ISSN 0003-4967.
- ↑ 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.
- ↑ Geissdorfer, W.; Moos, V.; Moter, A.; Loddenkemper, C.; Jansen, A.; Tandler, R.; Morguet, A. J.; Fenollar, F.; Raoult, D.; Bogdan, C.; Schneider, T. (2011). "High Frequency of Tropheryma whipplei in Culture-Negative Endocarditis". Journal of Clinical Microbiology. 50 (2): 216–222. doi:10.1128/JCM.05531-11. ISSN 0095-1137.
- ↑ Fenollar, Florence; Nicoli, François; Paquet, Claire; Lepidi, Hubert; Cozzone, Patrick; Antoine, Jean-Christophe; Pouget, Jean; Raoult, Didier (2011). "Progressive dementia associated with ataxia or obesity in patients with Tropheryma whipplei encephalitis". BMC Infectious Diseases. 11 (1). doi:10.1186/1471-2334-11-171. ISSN 1471-2334.
- ↑ Urbanski, Geoffrey; Rivereau, Philippe; Artru, Laure; Fenollar, Florence; Raoult, Didier; Puéchal, Xavier (2012). "Whipple Disease Revealed by Lung Involvement". Chest. 141 (6): 1595–1598. doi:10.1378/chest.11-1812. ISSN 0012-3692.
- ↑ Bruhlmann, P. (2000). "Diagnosis and therapy monitoring of Whipple's arthritis by polymerase chain reaction". Rheumatology. 39 (12): 1427–1428. doi:10.1093/rheumatology/39.12.1427. ISSN 1460-2172.
- ↑ Bauerfeind, Peter; Koelz, Hans-Rudolf; Altwegg, Martin (1999). "PCR for Tropheryma whippelii". The Lancet. 354 (9188): 1476–1477. doi:10.1016/S0140-6736(05)77620-0. ISSN 0140-6736.
- ↑ Fenollar, Florence; Puéchal, Xavier; Raoult, Didier (2007). "Whipple's Disease". New England Journal of Medicine. 356 (1): 55–66. doi:10.1056/NEJMra062477. ISSN 0028-4793.
- ↑ 13.0 13.1 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.
- ↑ 14.0 14.1 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.
- ↑ 15.0 15.1 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.
- ↑ 16.0 16.1 16.2 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.