Whipple's disease

Whipple’s disease is a rare infection caused by the gram positive bacterium tropheryma whipplei . It may involve any organ system but most frequently affects the GI tract.

Whipple’s disease tends to present with:
  • Weight loss
  • Diarrhoea
  • Fever
  • Arthralgia
  • Abdominal pain
It also causes malabsoption so patients may present with clinical manifestations of this – for example, with anaemia due to B12 deficiency.

Up to a third of patients will have cardiac involvement, classically culture-negative endocarditis.

Possible clinical signs include
Whipple’s disease is commonest in Caucasian males (8:1)

Diagnosis is by
  • Histology – foamy macrophages filled with periodic acid-Schiff (PAS) positive particles
  • PCR
Treatment is 2 weeks IV ceftriaxone then 1 year of oral co-trimoxazole (=trimethoprim/sulfamethozaxole)

Small print gem: the original name for Whipple's disease was "intestinal lipodystrophy"

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