Whipple’s Disease

As Whipple’s disease is a rare disease, the physician first seeks to rule out other related diseases. They are:
Inflammatory rheumatic (Painful swelling of joints) disease

  • Celiac disease
  • Neurological disorders
  • Intra-abdominal lymphoma
  • Mycobacterium avium complex (in people with AIDS )

What are the Methods of Diagnosis for Whipple’s Disease?

The diagnosis is done mainly by examining the small intestine. The following diagnostic tools are commonly used. They are:

General diagnostic tools include

  • Endoscopy
  • Biopsy (periodic acid-Schiff (PAS) staining is used)

Confirmatory diagnostic tools include

  • Electron microscopy
  • Polymerase chain reaction (PCR)

    – Used mostly to test the presence of bacterial DNA in body fluids> helps in the diagnosis of Neurological Whipple’s disease

Standard course of long-term antibiotics are used to nullify T. whipplei bacteria.

Normally initial treatment with intravenous (IV) antibiotics is given followed by daily oral antibiotic treatment for 1 to 2 years.

Normally a combination of antibiotics containing ceftriaxone (Rocephin) and penicillin G (Pfizerpen) plus streptomycin is given to the patients.

A combination of Trimethoprim/sulfamethoxazole (Septra, Bactrim) is given to treat neurological complications. This can enter the cerebrospinal fluid and easily reach the brain by crossing the blood brain barrier.

As an alternative even a combination of doxycycline (Vibramycin) and the antimalarial drug hydroxychloroquine (Plaquenil) is given for one year or more. This approach is followed with antibiotics like sulfamethoxazole, Which take longer time for breaching the blood brain barrier.

Prognosis of Whipple’s Disease

The general outcome for Whipple’s disease is very good. All the symptoms start receding within one month of the standard course of treatment. Relapse is not uncommon though . So there is need for constant medical supervision even after the disease is cured. Prognosis however is very poor in people with neurological complications.

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