Whipples disease | Medical Science Optional Notes for UPSC PDF Download

Etiology

• T. whipplei, a gram-positive bacillus belonging to the Actinobacteria group and measuring between 50-500 nm, exhibits low virulence but high infectivity.
• The disease predominantly affects middle-aged Caucasian males, and the reasons for this occurrence remain unexplained.

Clinical Presentation

• Whipple's disease typically begins gradually, marked by symptoms such as diarrhea, steatorrhea, abdominal pain, weight loss, migratory large-joint arthropathy, fever, and manifestations in the eyes and central nervous system.
• Dementia emerges as a relatively late symptom and serves as a particularly grim prognostic indicator, especially for individuals who relapse after achieving remission with antibiotic treatment.

Diagnosis

• A potential diagnosis of Whipple's disease arises when a patient presents with both diarrhea and steatorrhea as part of a multisystemic condition.
• The initial diagnostic step involves conducting a tissue biopsy of the small intestine and potentially other affected organs like the liver, lymph nodes, heart, eyes, central nervous system (CNS), or synovial membranes, based on the patient's symptoms.
• Detection of PAS-positive macrophages containing the distinctive small bacilli provides suggestive evidence for Whipple's disease.

Treatment

• Whipple's disease is treated with an extended course of antibiotics.
• The recommended treatment protocol involves administering ceftriaxone or meropenem for a duration of 2 weeks, followed by oral TMP-SMX (160/800 mg) twice daily for one year.
• In cases where trimethoprim-sulfamethoxazole is not well-tolerated, chloramphenicol is a suitable alternative as a second-line option.