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What is Whipple Disease
Whipple disease is a very rare type of bacterial infection. It cannot spread from person to person (is not contagious). Whipple disease attacks the digestive system and can cause diarrhea, joint pain, and weight loss.
The infection starts in the small intestine, where it interferes with the absorption of nutrients. This results in a condition called malabsorption or malnutrition, which is when the body does not have enough of the nutrients that it needs. The infection can also spread to other areas of the body, including the brain and heart.
What are the causes?
The infection is caused by Tropheryma whipplei(T. whipplei) bacteria. It is not known why some people get Whipple disease or why the bacteria turn into infection. The bacteria, which are found in soil and sewage, can also be found in healthy people.
What increases the risk?
This condition is more likely to develop in:
- Men.
- People who are 40–60 years of age.
- People who are white (Caucasian) or of European descent.
- People who work outside and are exposed to soil or sewage.
What are the signs or symptoms?
The most common symptoms of this condition are:
- Joint pain.
- Weight loss.
- Diarrhea.
- Pain in the abdomen.
What are the multisystem manifestations of Whipple disease?
W = Wasting and weight loss | D = Diarrhea |
H = Hyperpigmentation (skin) | I = Interstitial nephritis |
I = Intestinal pain | S = Skin rashes |
P = Pleurisy | E = Eye inflammation |
P = Pneumonitis | A = Arthritis |
L = Lymphadenopathy | S = Subcutaneous nodules |
E = Encephalopathy | E = Endocarditis |
S = Steatorrhea |
If the disease spreads through the body, many symptoms can develop, including:
- Fever.
- Abnormally low concentration of red blood cells or hemoglobin in the blood (anemia).
- Fatty or bloody bowel movements.
- Abdominal pain, bloating, and cramping.
- Swollen lymph nodes.
- Weakness and tiredness.
- Loss of appetite.
- Darkening of the skin.
- Changes in vision.
- Headaches.
- Mental changes.
- Trouble walking.
- Hearing loss.
- Chest pain.
- Cough.
- Heart failure.
- Fluid buildup (edema).
How is this diagnosed?
This condition is diagnosed based on your symptoms and a physical exam. You may have tests, including:
- Stool (feces) sample tests.
- Blood tests.
- Upper endoscopy. This is a procedure to look inside the upper GI (gastrointestinal) tract.
- Examination of a small piece of your intestinal lining (biopsy).
It can be difficult to diagnose Whipple disease because it is such a rare condition.
How is this treated?
This condition is treated with antibiotic medicine. The bacteria can be resistant to treatment. The infection also tends to come back. Because of this, you may need to take antibiotics for a long time. You may also need to switch to other antibiotics or take more antibiotics over time.
Treatment starts with 2 weeks of giving antibiotics through an IV tube into a vein. After 2 weeks, you may be able to switch to antibiotics that are taken by mouth (orally). You may have to take these antibiotics for 1 year or longer. If your brain and spinal cord are involved, you may also need to take medicine to strengthen your body’s defense system (immune system) and to suppress inflammation. You may need to have another endoscopy and biopsy to see if treatment is getting rid of the bacteria.
Follow these instructions at home:
- Take over-the-counter and prescription medicines only as told by your health care provider.
- Take your antibiotic medicine as told by your health care provider. Do notstop taking the antibiotic even if you start to feel better.
- Talk
with a diet and nutrition specialist (dietitian) about what you
should be eating and drinking in order to get enough nutrients. You may
need to:
- Eat a diet that is high in protein and high in calories.
- Take vitamins and nutritional supplements. Take these only as told by your health care provider.
Keep all follow-up visits as told by your health care provider. This is important.
Contact a health care provider if:
- Your symptoms get worse or they do not get better.
- You develop new symptoms.
- You continue to lose weight.
Get help right away if:
- You have a sudden loss of vision or speech.
- You cannot walk.
- You have chest pain.
- You have trouble breathing.
Summary
- Whipple disease is a very rare type of bacterial infection that attacks the digestive system. It can cause diarrhea, joint pain, and weight loss.
- This condition is treated with antibiotic medicine. The bacteria can be resistant to treatment. The infection also tends to come back. Because of this, you may need to take antibiotics for a long time. You may also need to switch to other antibiotics or take more antibiotics over time.
- Take your antibiotic medicine as told by your health care provider. Do notstop taking the antibiotic even if you start to feel better.
- Contact your health care provider if you develop new symptoms or if your symptoms get worse.