Whipple's disease

Whipple's disease is diagnosed during a small bowel biopsy . Mostly the disease affects people with white skin color, at the age from thirty to sixty years. This rather rare systemic disease is provoked by Tropheryma whippelii. Treatment of the disease involves taking Tremethoprim-sulfamethoxazole for at least one year.

Characteristic is the defeat of the mucosa of the small intestine in case of illness, and the symptoms appear corresponding. The main manifestations of the disease are diarrhea and weight loss. However, Whipple's disease affects many other organs and tissues (lungs, heart, serous cavities, brain, joints, gastrointestinal tract, eyes). On the background of the disease, arthritis develops, slight defects in cellular immunity are noted, predisposing to infection.

The first clinical manifestations of the disease are also characterized by the development of fever. A large number of patients have recurrent tracheobronchitis. The initial stages of the disease are characterized by the presence of migrating pain in large and small joints. As a rule, there are no signs of pronounced inflammation in them. Characteristic is the integrating arthritis, which, unlike rheumatoid arthritis, does not deform the joints.

The above clinical manifestations can be noted three to eight years before the development of the main symptoms.

Signs of affection of the gastrointestinal tract accompanying Whipple's disease (abdominal pain, steatorrhea, anorexia and others) occur during the further course of the disease, in its extended stage. Typical is chronic diarrhea. Emptying occurs five to ten times a day very abundantly with the release of fat in large quantities. In addition, in some cases, characteristic can become latent or profuse bleeding in the intestine. Such phenomena, as a rule, are associated with a disorder of coagulation as a result of hypoprothrombinemia. This condition is due to a defect in the absorption of K-vitamin. It should be noted that diarrhea is considered a common symptom, however, it is not mandatory.

Some patients experience constipation, especially in the initial stages of the disease. The late stages of the clinical development of pathology are accompanied by the appearance and diagnosis of severe malabsorption. In a number of other studies, increased pigmentation of the skin, an increase in lymph nodes, anemia, polyserositis, chronic cough, signs of a CNS disorder, as well as peripheral edema.

On examination, the patient feels painful at the palpation of the umbilical region, which decreases after the act of defecation and removal of gases.

It should be noted that pain in the mesogastric can have varying intensity. In some cases, they appear in the form of raspirany after eating, at times - in the form of colic. With severe pain and flatulence in patients with suspected ileus (closure or narrowing of the intestinal lumen), they are hospitalized for surgery.

Whipple's disease can be diagnosed in individuals without GI symptoms. If suspicion of the onset of the disease is performed endoscopy of the upper sections of the digestive tract, a biopsy of the small intestine. When identifying specific lesions, a diagnosis is made. As a rule, persistent and significant changes affect the proximal parts.

In the absence of timely and competent treatment, the ailment progresses quickly enough and can become fatal. Various antibiotics (tetracycline, chloramphenicol, trimethoprim-sulfamethoxazole, ampicillin, cephalosporins, penicillin) are considered effective.