Whipple disease

Whipple disease Whipple's disease is a multi-systemic bacterial infection, which interfere with the body's ability to metabolize fat. The disease can affect any system in the body, to include the central nervous, but usually develops in the digestive tract. Gastrointestinal symptoms may include diarrhea, weight loss, fatigue, pain and intestinal bleeding. Neurological symptoms may be pathological changes facial expression muscles of eyeball, confusion, ataxia, seizures, loss of vision and memory. Fever, cough and sore joints may also be present. Whipple's disease affects mostly Caucasian men between 30 and 60 years. It is an infection caused by Tropheryma whipplei. The infection usually affects the intestines, but can meet and lung, heart, joints, eyes and brain. Diagnosis is made by histologic examination and culture of intestinal biopsy pieces. The disease is cured with antibiotics.
Pathogenesis Clinical manifestations of the disease could be due to infiltration of various tissues T.whipplei. Patient's immune system reacts to bacteria embedded tissue macrophages. These tissues infiltrated macrophages may be observed by direct microscopy. Electron microscopy shows cocobacili and a positive PCR test T.whipplei is present in tissues. Malabsorption observed in the small intestine associated with this disease is considered to be secondary damage by infiltrating lamina vilozitare their function in the gut. Patients with arthralgia shows the organism in the synovial fluid, those with neurological impairment in CSF. Rare bacteria can be detected in the lungs.
Signs and symptoms The classic clinical presentation Whipple disease starts with weakness and pain, arthritis, fever, diarrhea. Lymphadenopathy may be present. If seats are involved bowel steatorrhea. Approximately 90% of patients experience weight loss, and 70% complain of diarrhea and arthralgia. Occult Gastrointestinal Bleeding can be seen in 80% of patients, but frank hematochezia is rara.In 30% of cases involved and heart symptoms. Signs and symptoms encountered include: -Cachexia, distended abdomen -Glossitis, Perles Trousseau and Chvostek-sign-secondary hypocalcemia -Gingivitis and gum bleeding-secondary deficiency of vitamin C Temporary night-blindness, vitamin A deficiency secondary Noisy, visible peristaltic fluid aerice -Orbital and malar hyperpigmentation areas -Swollen joints.
Diagnosis A biopsy is the test most accurately, the sample may be brain tissue, heart or intestinal.Examenul electron microscope shows vilozitare function abnormalities, lamina propria infiltration of the wall is intestinal.Testul acid Schiff positive macrophages. Other tests used are: -PCR Applied magnetic-resonance brain Abdominal CT-coputer -Determination of the percentage of fat in the stool -Laboratory tests demonstrate malabsorption: serum albumin, serum carotene, prothrombin time.
Treatment Treatment is medication, in order to eradicate the infection and prevent complications: Trimethoprim-sulfamethoxazole-inhibit bacterial growth by blocking the synthesis of dihydrofolate acid Penincilina G-therapy is an alternative to TMP-SMZ, interfere with bacterial cell wall lipid synthesis in division AC-streptomycin-treatment, followed by a year of TMP-SMZ. VK-penincilina-used by patients allergic to sulfur drugs -Amoxicillin-mucopeptidelor interfere with bacterial cell wall synthesis, active in the division -Chloramphenicol-50 acts by coupling ribosome subunit and inhibit bacterial growth by blocking protein synthesis. The infection can remain persistent despite antibiotic treatment. Relapses are common. Wipple untreated disease is fatal for most patients after one year evolution.