Sandbox: wdx: Difference between revisions
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==Overview== | ==Overview== | ||
Patients with Whipple's disease have varied presentation. Most common symptoms of | Patients with Whipple's disease have varied presentation. Most common symptoms of the classical Whipple's disease include [[joint pain]], [[weight loss]], [[diarrhea]], and [[arthropathy]]. Other organ systems can be involved in Whipple's disease including [[central nervous system]], [[cardiac]] system, [[renal]] system, [[skeletal]], [[muscles]] and [[pulmonary]] system. | ||
==History and Symptoms== | ==History and Symptoms== | ||
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====Articular system==== | ====Articular system==== | ||
* Intermittent migratory [[arthralgias]]: The second most common complaint | * Intermittent migratory [[arthralgias]]: The second most common complaint | ||
* [[arthritis]]: | * [[arthritis]]: Affecting peripheral joints, such as [[knees]], [[elbows]], [[wrists]] | ||
* Multiple [[joint]] involvement | * Multiple [[joint]] involvement | ||
== Less Common Symptoms == | == Less Common Symptoms == | ||
''' | '''Central nervous system''' | ||
* Asymptomatic involvement with detection of | * Asymptomatic involvement with detection of [[Tropheryma whipplei]] [[DNA]] in [[CSF]]: The most common finding | ||
* Focal CNS involvement | * Focal CNS involvement: | ||
* [[dementia]] | ** [[dementia]] | ||
* [[cerebral ataxia]] | ** [[cerebral ataxia]] | ||
* [[hemiparesis]] | ** [[hemiparesis]] | ||
* | ** [[Personality changes]] | ||
* [[opthalmoplegia]] | ** [[opthalmoplegia]] | ||
* [[nystagmus]] | ** [[nystagmus]] | ||
* | ** Supranuclear opthalmoplegia (50% of patients) | ||
* [[myoclonus]] | ** [[myoclonus]] (25% of patients) | ||
* | * [[Hypothalamic]] involvement (rarely) | ||
* | ** P[[polydipsia|olydipsia]] | ||
* CNS involvement usually has poor prognosis. <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="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> | ** [[hyperphagia]] | ||
'''Ocular involvement''' | ** Change in [[libido]] | ||
** Change in sleep wake cycle | |||
* [[Eye movements|Eye movement]] abnormalities (pathognomic) | |||
** Oculomasticatory myorhythmia (OMM) | |||
** Oculofacial-skeletal myorhythmia (OSFM) | |||
* CNS involvement usually has poor prognosis.<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="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> | |||
'''Ocular involvement''' | |||
rare and can involve: <ref name="pmid11432814" /> | |||
* [[uveitis]], | * [[uveitis]], | ||
* [[retinitis]] , | * [[retinitis]] , | ||
Revision as of 02:48, 8 November 2017
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Whipple's disease Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Sandbox: wdx On the Web |
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American Roentgen Ray Society Images of Sandbox: wdx |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Bhagyashree Deshmankar M.B.B.S.[2]
Overview
Patients with Whipple's disease have varied presentation. Most common symptoms of the classical Whipple's disease include joint pain, weight loss, diarrhea, and arthropathy. Other organ systems can be involved in Whipple's disease including central nervous system, cardiac system, renal system, skeletal, muscles and pulmonary system.
History and Symptoms
Common Symptoms
Non specific symptoms
Gastrointestinal system
- Diarrhea: The most common complaint
- Steatorrhea
- Abdominal pain
- Occult mucosal bleeding
- Ascites
- Hepatosplenomegaly
- Hepatitis
Articular system
- Intermittent migratory arthralgias: The second most common complaint
- arthritis: Affecting peripheral joints, such as knees, elbows, wrists
- Multiple joint involvement
Less Common Symptoms
Central nervous system
- Asymptomatic involvement with detection of Tropheryma whipplei DNA in CSF: The most common finding
- Focal CNS involvement:
- dementia
- cerebral ataxia
- hemiparesis
- Personality changes
- opthalmoplegia
- nystagmus
- Supranuclear opthalmoplegia (50% of patients)
- myoclonus (25% of patients)
- Hypothalamic involvement (rarely)
- Polydipsia
- hyperphagia
- Change in libido
- Change in sleep wake cycle
- Eye movement abnormalities (pathognomic)
- Oculomasticatory myorhythmia (OMM)
- Oculofacial-skeletal myorhythmia (OSFM)
- CNS involvement usually has poor prognosis.[1][2]
Ocular involvement
rare and can involve: [2]
- uveitis,
- retinitis ,
- vitritis
- retrobulbar neuritis
- papilledema .
- Ocular involvement is often seen in patients with CNS disease. [2]
Skeletal muscle involvement
Cardiac involvement :may have varied presentation .[1] [2]
- pericarditis
- myocarditis
- heart failure
- sudden Cardiac death
- Endocarditis : associated with negative blood cultures. Endocarditis is often preceded by arthritis and arthralgias .[1] [2]
Pulmonary involvement [2]
- manifest as pleuritic chest pain
- non productive cough
- dyspnea
- Chest x-ray often shows pleural effusion , pulmonary infiltration, or granulomatous mediastinal adenopathy. Often abdominal lymph nodes may be involved.
Hematological finding
Cutaneous finding
- melanoderma : less frequently reported these days as Whipple's disease is increasingly recognized early. [1]
Renal involvement : late in course, may be seen rarely. [1]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Fenollar F, Puéchal X, Raoult D (2007). "Whipple's disease". N Engl J Med. 356 (1): 55–66. doi:10.1056/NEJMra062477. PMID 17202456.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 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.