Whipples Disease

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Whipples Disease is a rare bacterial infection that most often affects your gastrointestinal system. It interferes with normal digestion, impairing the breakdown of foods such as fats and carbohydrates and hampering your body's ability to absorb nutrients. This absorption problem occurs when the infection damages the lining of your small intestine.

In addition to affecting your intestinal tract, Whipple's disease can infect other organs, including your brain, heart, joints and eyes.

No matter which part of your body Whipples disease affects, a lengthy course of antibiotics can provide successful treatment. But without proper treatment, Whipple's disease can be fatal.

Many common signs and symptoms of Whipple's disease involve the gastrointestinal system and include:

  • Diarrhea
  • Abdominal cramping and pain
  • Weight loss, associated with the malabsorption of nutrients
  • Inflamed joints, particularly your ankles, knees and wrists

  • Abdominal pain tends to worsen after meals in some cases.

    Other frequent signs and symptoms associated with Whipple's disease include:
  • Fatigue
  • Weakness
  • Anemia

  • Less common signs and symptoms are:
  • Low-grade fever
  • Cough
  • Enlarged lymph nodes
  • Difficulty walking
  • Skin darkening in areas exposed to the sun, and in scars
  • Visual impairment, including lack of control of eye movements
  • Discomfort while breathing, due to inflammation of the membranes lining the lungs
  • Heart murmurs
  • Enlarged spleen
  • Seizures
  • Confusion
  • Memory loss

  • Symptoms tend to develop slowly over a period of several years in most people with the disease.

    The cause of Whipple's disease is infection with the bacterium Tropheryma whippelii, also known as Whipple bacillus. This bacterium can initially affect the mucosal lining of your small intestine, forming small lesions within the intestinal wall. With time, the infection can spread to other parts of your body.

    Cases of Whipples disease have been noted to run in families. Some researchers believe that people with the disease may have a genetic defect in their immune system response that makes them more susceptible to becoming ill when exposed to the bacterium.

    Treatment of Whipple's disease is with antibiotics, which can destroy the bacteria and the lesions they've caused. Use of antibiotics is considered a lifesaving therapy.
    Your doctor may choose from a number of antibiotics, all of which have proved effective in treating Whipples disease, either alone or in combination. They include:

  • Sulfasalazine (Azulfidine)
  • Trimethoprim-sulfamethoxazole, or TMP-SMX (Bactrim, Septra)
  • Ceftriaxone
  • Tetracycline
  • Doxycycline
  • Erythromycin
  • Streptomycin
  • Ampicillin
  • Penicillin G

  • . . . Long course of treatment
    Treatment is long term, and doctors may prescribe a variety of drug doses and schedules. A typical course of therapy requires hospitalization, with 14 days of intravenous (IV) ceftriaxone, followed by oral doses of TMP-SMX for one to two years on an outpatient basis. A shorter duration of antibiotic treatment may lead to a relapse.

    Another common treatment begins with 14 days of IV infusions of streptomycin and penicillin G, followed by oral TMP-SMX for one to two years.

    For the most serious cases, fluids and electrolyte replacement via IV drip may be added during initial hospitalization. Electrolytes are minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body.

    Because of the lengthy use of antibiotics, your doctor will need to monitor your condition for development of resistance to the drugs.

    When choosing antibiotics, doctors often select those that not only eradicate infections of the intestinal tract, but also cross the blood-brain barrier — a layer of tissue around your brain — in order to eliminate bacteria that may have entered your brain and central nervous system.

    . . . Possible rapid relief
    Relief of symptoms tends to be rapid with proper antibiotic treatment. If you're experiencing joint pain, you may notice improvement in only a few days. Your diarrhea may go away within a week, and weight gain may begin just as soon.

    Most other symptoms should subside within one to three months. But even though symptoms improve quickly, further laboratory tests may reveal presence of the bacteria for up to two years after you begin taking antibiotics. Follow-up testing will help your doctor determine when you can stop taking antibiotics. Regular monitoring can also indicate occurrence of resistance to a particular drug, often reflected in a lack of improvement of your symptoms.

    To manage joint pain, your doctor may recommend a nonsteroidal anti-inflammatory medication, such as ibuprofen, as well.

    Even after successful treatment, Whipples disease can recur. Doctors usually advise regular checkups. If you've experienced a recurrence, you'll need to repeat antibiotic therapy.

    . . . Taking supplements
    Because of the nutrient-absorption difficulties associated with Whipple's disease, your doctor may recommend taking vitamin and mineral supplements to ensure adequate nutrition. Your body may require additional vitamin D, folic acid, calcium, iron and magnesium.


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