Sandbox: wdx
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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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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
- Whipple's disease is a rare bacterial systemic infection caused by Tropheryma whipplei.[1]
- Tropheryma whipplei is a periodic acid-Schiff stain positive, gram-positive bacillus of Actinomycetes family.[2]
- 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. [3]
- It is transmitted through oro-oral and feco-oral routes. The poor sanitation is associated with T. whipplei infection. [4]
- It is believed that human being is the only host for this bacterium.[5]
- It invades intestines primarily and then every other organ including the heart, CNS, joints, lymph nodes, skin, lungs and the eyes.
- Tissues are infected by macrophage infiltration contaminated by Tropheryma whipplei. T. whipplei multiplies in macrophages and monocytes. [6]
- Tropheryma whipplei infection causes four different clinical manifestations: acute infection, the classic Whipple’s disease, asymptomatic carrier state, and localized chronic infection.[7] [8]
- It is believed that host immunologic response to the microorganism plays an important role on the clinical manifestation of the disease.[6]
| Contamination via oro-oral or feco-oral route | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Acute infection | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Antibodies production | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Strong immune response | Insufficient immune response | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Complete eradication | Chronic carrier | Chronic infection | |||||||||||||||||||||||||||||||||||||||||||||||||||
Immunologic response
Genetics
There is no known causative genetic factor for Whipple's disease. However, there is an association between Whipple's disease and some immunologic defects.
- HLA (HLA alleles DRB1*13 and DQB1*06) and Whipple’s disease.
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
- 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.[9]
Below images show the characteristic feature of Whipple's disease. foamy macrophages are present in the lamina propria.[10]
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![Low magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)[11]](/images/3/3a/Whipple_disease_low_mag.jpg)
Low magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)[11]
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![Intermediate magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)[12]](/images/9/92/Whipple_disease_-_intermed_mag.jpg)
Intermediate magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)[12]
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![High magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)[13]](/images/e/e3/Whipple_disease_high_mag.jpg)
High magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)[13]
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![Very high magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)[14]](/images/1/1a/Whipple_disease_very_high_mag.jpg)
Very high magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)[14]
![Low magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)[11]](/index.php/File:Whipple_disease_low_mag.jpg)
![Intermediate magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)[12]](/index.php/File:Whipple_disease_-_intermed_mag.jpg)
![High magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)[13]](/index.php/File:Whipple_disease_high_mag.jpg)
![Very high magnification micrograph of Whipple's disease. H&E stain. Duodenal biopsy. By Nephron (Own work)[14]](/index.php/File:Whipple_disease_very_high_mag.jpg)
References
- ↑ 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.
- ↑ 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.
- ↑ Keita, Alpha Kabinet; Diatta, Georges; Ratmanov, Pavel; Bassene, Hubert; Raoult, Didier; Roucher, Clémentine; Fenollar, Florence; Sokhna, Cheikh; Tall, Adama; Trape, Jean-François; Mediannikov, Oleg (2013). "Looking for Tropheryma whipplei Source and Reservoir in Rural Senegal". The American Journal of Tropical Medicine and Hygiene. 88 (2): 339–343. doi:10.4269/ajtmh.2012.12-0614. ISSN 0002-9637.
- ↑ 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.
- ↑ 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.
- ↑ 6.0 6.1 Marth T, Strober W (1996). "Whipple's disease". Semin. Gastrointest. Dis. 7 (1): 41–8. PMID 8903578.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ https://commons.wikimedia.org
- ↑ CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15357443
- ↑ CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15357450
- ↑ CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15357481
- ↑ CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15357462