Whipple disease: Symptoms, Treatment

Overview

Whipple disease is a rare bacterial infection that primarily affects your joints and digestive system. By impairing the breakdown of foods, this condition makes the digestion abnormal. The infection can also spread to other organs in your body, such as the heart, eyes, lungs and central nervous system. Untreated Whipple disease can be life-threatening.

The annual prevalence of this rare disease
is 1:1,000,000, and it most often affects middle-aged Caucasian men.

Symptoms

Common symptoms

People with Whipple disease usually have symptoms associated with the digestive system, such as:

  • Diarrhea
  • Abdominal cramping and pain (which may worsen after meals)
  • Weight loss (which is related to the malabsorption of nutrients)

Other symptoms may involve:

  • Inflamed joints (particularly the ankles, knees, and wrists)
  • Fatigue
  • Weakness
  • Anemia

Less common symptoms

Less common symptoms may include:

  • Fever
  • Cough
  • Enlarged lymph nodes
  • Skin darkening in areas exposed to the sun and in scars
  • Chest pain
  • Enlarged spleen
  • Difficulty walking
  • Visual impairment, including lack of control of eye movements
  • Confusion
  • Memory loss

Causes

A type of bacterium called Tropheryma whipplei
cause Whipple disease. The infection of this type of bacterium will bring about
small lesions within the intestinal wall as well as damage on the fine, hairlike
projections that line the small intestine.

However, not everyone with Tropheryma whipplei develops the disease. More relevant information about the bacteria is needed. A genetic defect in the immune system response is considered to be one factor that makes a group of people more likely to get sick when exposed to the bacteria.

Diagnosis

A doctor may use the following tests to make
a diagnosis of Whipple disease:

  • Medical and family history
  • Physical exam
  • Blood tests
  • Upper GI endoscopy and enteroscopy

Some conditions that have similar signs or
symptoms need to be ruled out. They include:

  • Inflammatory rheumatic disease
  • Celiac disease
  • Neurologic diseases
  • Intra-abdominal lymphoma
  • Mycobacterium avium complex

Treatment

Treatment for Whilpple disease is a long-term antibiotic therapy which generally lasts one or two years. Antibiotics that can both wipe out infections of the intestinal tract and cross a layer of tissue around the brain are often chosen so that bacteria entering the brain and central nervous system can be eliminated.

In most cases, people with no brain or nervous system complications can recover completely after receiving a full course of antibiotics. During the therapy, the doctor will monitor your condition of resistance to the drugs. This enables your doctor to change antibiotics as soon as possible if relapse occurs.

Treatment for standard cases

To treat most cases, your doctor usually first uses intravenous (IV) ceftriaxone or penicillin for two or four weeks. After that, an oral course of sulfamethoxazole-trimethoprim (Bactrim, Septra) will be taken for one to two years.

Besides, oral doxycycline (Vibramycin, Monodox, others) combined with the antimalarial drug hydroxychloroquine (Plaquenil) is used as an alternative in some cases.

Treatment result

Although your symptoms may improve within
one or two weeks since the beginning of therapy and disappear entirely within about
one month, the doctor can still find the bacteria in your body for two or even
more years. Therefore, your doctor will determine whether you can stop taking
antibiotics with follow-up testing.

It is likely that Whipple disease recurs
after treatment. If recurrence happens, you will have therapy again.

Taking supplements

Considering that your body may require additional vitamin D, folic acid, calcium, iron, and magnesium because of nutrient-absorption difficulties caused by the disease, you may need to take vitamin and mineral supplements.



Keyword: Whipple disease.

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