Difference between revisions of "Whipple's disease"

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      = Whipple_disease_-a-_high_mag.jpg
| Image      = Whipple disease - very high mag.jpg
| Width      =
| Width      =
| Caption    = Whipple's disease. [[H&E stain]].
| Caption    = Whipple's disease. [[H&E stain]].
| Synonyms  =
| Synonyms  =
| Micro      = infectious microorganisms - typically in macrophages; macrophages usually abundant  
| Micro      = rod-shaped microorganisms - typically in macrophages; lamina propria macrophages usually abundant  
| Subtypes  =
| Subtypes  =
| LMDDx      = [[mycobacterium avium complex]]  
| LMDDx      = [[mycobacterium avium complex]]  
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| Tx        = antibiotics
| Tx        = antibiotics
}}
}}
'''Whipple's disease''' is a rare infectious disease that is classically in the [[duodenum]].
'''Whipple's disease''' is a rare infectious disease that is classically found in the [[duodenum]].


==General==
==General==
Etiology:
Etiology:
*Infection - caused by ''Tropheryma whipplei''<ref name=pmid11777846>{{cite journal |author=Liang Z, La Scola B, Raoult D |title=Monoclonal antibodies to immunodominant epitope of Tropheryma whipplei |journal=Clin. Diagn. Lab. Immunol. |volume=9 |issue=1 |pages=156?9 |year=2002 |month=January |pmid=11777846 |pmc=119894 |doi= |url=http://cvi.asm.org/cgi/pmidlookup?view=long&pmid=11777846}}</ref> a rod-shaped organisms.<ref name=pmid11764080>{{Cite journal  | last1 = Alkan | first1 = S. | last2 = Beals | first2 = TF. | last3 = Schnitzer | first3 = B. | title = Primary diagnosis of whipple disease manifesting as lymphadenopathy: use of polymerase chain reaction for detection of Tropheryma whippelii. | journal = Am J Clin Pathol | volume = 116 | issue = 6 | pages = 898-904 | month = Dec | year = 2001 | doi = 10.1309/7678-E2DW-HFJ5-QYUJ | PMID = 11764080 }}</ref>
*Infection - caused by ''Tropheryma whipplei''<ref name=pmid11777846>{{cite journal |author=Liang Z, La Scola B, Raoult D |title=Monoclonal antibodies to immunodominant epitope of Tropheryma whipplei |journal=Clin. Diagn. Lab. Immunol. |volume=9 |issue=1 |pages=156?9 |year=2002 |month=January |pmid=11777846 |pmc=119894 |doi= |url=http://cvi.asm.org/cgi/pmidlookup?view=long&pmid=11777846}}</ref> a rod-shaped organism.<ref name=pmid11764080>{{Cite journal  | last1 = Alkan | first1 = S. | last2 = Beals | first2 = TF. | last3 = Schnitzer | first3 = B. | title = Primary diagnosis of whipple disease manifesting as lymphadenopathy: use of polymerase chain reaction for detection of Tropheryma whippelii. | journal = Am J Clin Pathol | volume = 116 | issue = 6 | pages = 898-904 | month = Dec | year = 2001 | doi = 10.1309/7678-E2DW-HFJ5-QYUJ | PMID = 11764080 }}</ref>


Epidemiology:
Epidemiology:
Line 46: Line 46:
Treatment:
Treatment:
*Antibiotics - for months and months.
*Antibiotics - for months and months.
==Gross==
*Pale yellow or white spots.<ref>{{Cite journal  | last1 = Salkic | first1 = NN. | last2 = Alibegovic | first2 = E. | last3 = Jovanovic | first3 = P. | title = Endoscopic appearance of duodenal mucosa in Whipple's disease. | journal = Gastrointest Endosc | volume = 77 | issue = 5 | pages = 822-3; discussion 823 | month = May | year = 2013 | doi = 10.1016/j.gie.2013.01.016 | PMID = 23490230 }}</ref>


==Microscopic==
==Microscopic==
Features:<ref name=pmid15476147>{{cite journal | author=Bai J, Mazure R, Vazquez H, Niveloni S, Smecuol E, Pedreira S, Mauriño E | title=Whipple's disease | journal=Clin Gastroenterol Hepatol | volume=2 | issue=10 | pages=849?60 | year=2004 | pmid=15476147  | doi=10.1016/S1542-3565(04)00387-8}}</ref>
Features:<ref name=pmid15476147>{{cite journal | author=Bai J, Mazure R, Vazquez H, Niveloni S, Smecuol E, Pedreira S, Mauriño E | title=Whipple's disease | journal=Clin Gastroenterol Hepatol | volume=2 | issue=10 | pages=849?60 | year=2004 | pmid=15476147  | doi=10.1016/S1542-3565(04)00387-8}}</ref>
*Infectious microorganism typically found in macrophages.
*Rod-shaped microorganisms - typically found in macrophages.
**Macrophages usually abundant - '''key feature''' that should raise Dx in DDx.
**Macrophages usually abundant - '''key feature''' that should raise Dx in DDx.
**Organisms periodic acid-Schiff (PAS) positive.
**Organisms periodic acid-Schiff (PAS) positive.


DDx:
DDx:
*[[Mycobacterium avium complex]] (MAC).
*[[Mycobacterium avium complex]] (MAC) - not hole-y.
*Crushed Brunner's glands - PAS-Alcian blue stain +ve (like Whipple's disease).


===Images===
===Images===
<gallery>
<gallery>
Image:Whipple_disease_-_intermed_mag.jpg | Whipple disease - intermed. mag. (WC)
Image: Whipple disease - low mag.jpg | Low mag.
Image:Whipple_disease_-a-_high_mag.jpg | Whipple disease - high mag. (WC)
Image: Whipple disease - intermed mag.jpg | Intermed. mag.
Image: Whipple disease - high mag.jpg | High mag.
Image: Whipple disease - very high mag.jpg | Very high mag.
</gallery>
<gallery>
Image: Whipple disease -a- high mag.jpg | High mag.
Image: Whipple disease -a- very high mag.jpg | Very high mag.
</gallery>
<gallery>
Image:Whipple2.jpg | Whipple disease - poor quality - low mag. (WC)
Image:Whipple2.jpg | Whipple disease - poor quality - low mag. (WC)
</gallery>
</gallery>
==Stains==
==Stains==
*PAS +ve organisms.
*PAS +ve organisms.
*[[AFB stain]] -ve -- to r/o [[MAI]].
*[[AFB stain]] -ve -- to r/o [[MAI]].


Image:
===Images===
*[http://www.biomedcentral.com/content/figures/1472-6823-6-3-2-l.jpg Whipple disease - PAS stain (biomedcentral.com)].
*[http://www.biomedcentral.com/content/figures/1472-6823-6-3-2-l.jpg Whipple disease - PAS stain (biomedcentral.com)].
*[https://www.flickr.com/photos/euthman/6881958781/ Whipple disease - PAS (flickr.com/euthman)].


==See also==
==See also==
*[[Duodenum]].
*[[Duodenum]].
*[[Colorectal xanthomatous polyp]].


==References==
==References==

Latest revision as of 15:01, 30 May 2020

Whipple's disease
Diagnosis in short

Whipple's disease. H&E stain.

LM rod-shaped microorganisms - typically in macrophages; lamina propria macrophages usually abundant
LM DDx mycobacterium avium complex
Stains PAS +ve (microorganisms), AFB -ve
Site duodenum

Clinical history usu. middle aged men
Signs diarrhea
Prevalence very rare
Prognosis good
Treatment antibiotics

Whipple's disease is a rare infectious disease that is classically found in the duodenum.

General

Etiology:

  • Infection - caused by Tropheryma whipplei[1] a rod-shaped organism.[2]

Epidemiology:

  • Very rare.
  • Classically middle aged men.

Clinical

  • Malabsorption (diarrhea), arthritis + others.
    • Symptoms are non-specific.

Treatment:

  • Antibiotics - for months and months.

Gross

  • Pale yellow or white spots.[3]

Microscopic

Features:[4]

  • Rod-shaped microorganisms - typically found in macrophages.
    • Macrophages usually abundant - key feature that should raise Dx in DDx.
    • Organisms periodic acid-Schiff (PAS) positive.

DDx:

Images

Stains

Images

See also

References

  1. Liang Z, La Scola B, Raoult D (January 2002). "Monoclonal antibodies to immunodominant epitope of Tropheryma whipplei". Clin. Diagn. Lab. Immunol. 9 (1): 156?9. PMC 119894. PMID 11777846. http://cvi.asm.org/cgi/pmidlookup?view=long&pmid=11777846.
  2. Alkan, S.; Beals, TF.; Schnitzer, B. (Dec 2001). "Primary diagnosis of whipple disease manifesting as lymphadenopathy: use of polymerase chain reaction for detection of Tropheryma whippelii.". Am J Clin Pathol 116 (6): 898-904. doi:10.1309/7678-E2DW-HFJ5-QYUJ. PMID 11764080.
  3. Salkic, NN.; Alibegovic, E.; Jovanovic, P. (May 2013). "Endoscopic appearance of duodenal mucosa in Whipple's disease.". Gastrointest Endosc 77 (5): 822-3; discussion 823. doi:10.1016/j.gie.2013.01.016. PMID 23490230.
  4. Bai J, Mazure R, Vazquez H, Niveloni S, Smecuol E, Pedreira S, Mauriño E (2004). "Whipple's disease". Clin Gastroenterol Hepatol 2 (10): 849?60. doi:10.1016/S1542-3565(04)00387-8. PMID 15476147.