-
Working in a laboratory, I see very few 'real patients'
and follow some cases through clinical reports from my
colleagues and friends.
Then I read med. literature and case reports, of course.
In the last few years Whipple's Disease (WD) has drawn
my attention for various reasons:
- Intriguing clinical presentations.
- technical difficulties in making diagnosis.
- cheap, easy and instantly accessible cure (when caught on time).
- defined as a 'very rare' disease, but underdiagnosed frequently.
- many cases reported from Europe (many in U.K., Germany and Switzerland?).
- first observed one century ago (1907), it is still a sort of 'mystery'.
"Earlier diagnosis leads to earlier treatment and hopefully the prevention of chronic disabling complications and needless mortality from this once uniformly fatal condition." James DG and Lipman MC, 2002 (see below)
I open the discussion with simple bits and pieces plus whipple-pictures
Hope many of the NKSforum readers will partecipate in this open thread.
(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.scienceimage.csiro.au%2Findex.cfm%3Fevent%3Dsite.image.thumbnail%26amp%3Bid%3D188%26amp%3Bviewfile%3Df%26amp%3Bdivid%3DPP&hash=a96f98fa1b2182344aa48cc7b2b4ab29) (https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.sanger.ac.uk%2FInfo%2FPress%2Fgfx%2F030221_T_whipplei_300.jpg&hash=9972c634da597069d7db0bb9b91515f6)
http://www.scienceimage.csiro.au/index.cfm?event=site.image.thumbnail&id=188&viewfile=f&divid=PP
http://www.sanger.ac.uk/Info/Press/gfx/030221_T_whipplei_300.jpg
I overstressed on purpose intriguing reports from medical literature to open the discussion on how to find a cheap and easy way to avoid these treatable ailments going undetected for months and years, with all the human suffering involved.
In a few words, modern PCR technology will eventually allow us -in the near future- to develop special inexpensive microchips to detect by one simple blood test most of the germs that we carry 'on board'.
An infectious disease will be diagnosed in seconds starting from the germ this time, not from patients' medical history, signs and symptoms.
Quite a little revolution in clinical medicine, but today we do already use other 'screening' tests.
Of course we'll need top notch sensitivity and the highest number of bugs searched through a single test, to make it reliable, easy and cheap.
Unfortunately, these days we see some of this magic hightech show used mostly in forensic medicine.
ikodnotes [^]
(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fimages.the-scientist.com%2Fcontent%2Ffigures%2F0890-3670-050411-44-1-1.jpg&hash=7dab6b935733db9ecf2887c3cf84b672) (https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.five.tv%2Fmedia%2Fimage%2F11970633.jpg&hash=bb8706025fab61bc51d70365f211aa78)
http://images.the-scientist.com/content/figures/0890-3670-050411-44-1-1.jpg
http://www.five.tv/media/image/11970633.jpg
The Bug
What is it?
Where is it found?
How is it transmitted?
What diseases does it cause?
Who/what is at risk of infection?
click here for free full-text!
http://microbiology.mtsinai.on.ca/bug/TW/tw-bug.shtml
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Is whipples disease absolutely without any symptoms Like this post! LOL LOL.. Hugs IKO
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Yes Karen,
Whipple's disease is so variegated in terms of symptoms
that goes from nothing to any sign or symptom you can imagine!
This makes it useless to report their list.
(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.whipplesdisease.net%2FBacterium%2Fa_T_whippelii.jpg&hash=7d7ebc20b9b2b9983d835091938158f1) (https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fgiornale.regione.marche.it%2Farchivio%2Fnum0203%2Fspeciale%2Ffoto12bg.jpg&hash=452dddd3f495021afbe6b579f7793d89)
http://www.whipplesdisease.net/Bacterium/a_T_whippelii.jpg
http://giornale.regione.marche.it/archivio/num0203/speciale/foto12bg.jpg
A visible bacterium which is reluctant to common cultivation
By means of electron microscopy, the bacterium of Whipple´s disease is well characterized as rod-shaped, approximately 2,5 um in length, with a diameter of 0,25 um.
Its most peculiar ultrastructural feature is a trilaminar membrane with a broad electron dense outer layer. ( 1, 2 )
Since the bacterial nature of Whipple´s disease was recognized in 1961, several attempts were performed to culture the associated bacterium. Some of them were initially assumed to have been successful, but their results could never be reproduced by others. ( 3, 4, 5, 6 )
In 2000, a first case of successful cultivation associated with human fibroblast cell lines was reported, which eventually could be reconfirmed. ( 7, 8; 6 ) In 2003, the new knowledge of the genome provided information for a first in vitro cultivation without host cells ( 9 ). (see: Bacterium/Growth )
more from: http://www.whipplesdisease.net/Bacterium/hauptteil_bacterium.html
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The Bug
What is it?
Where is it found?
How is it transmitted?
What diseases does it cause?
Who/what is at risk of infection?
click here for free full-text!
http://microbiology.mtsinai.on.ca/bug/TW/tw-bug.shtml
1 Century Ago!
http://www.whipplesdisease.net/
(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.whipplesdisease.net%2FHistory%2FHistorical_Case%2FWhipple1907-1.jpg&hash=9b10614e3c4eb16f081692df17d78c14)
http://www.whipplesdisease.net/History/Historical_Case/Whipple1907-1.jpg
http://www.whipplesdisease.net/
-
Working in a laboratory, I see very few 'real patients'
and follow some cases through clinical reports from my
collegues and friends.
Then I read med. literature and case reports, of course.
In the last few years WD draw my attention for various
reasons:
- Intriguing clinical presentations.
- technical difficulties in making diagnosis.
- cheap, easy and instantly accessible cure (when caught on time).
- reported as a 'very rare' disease, but underdiagnosed frequently.
- cases found more often in Europe (many in Germany and Switzerland?).
I open the discussion with simple bits and peaces plus whipple-pics
Hope many of the NKSforum readers will partecipate in this open thread.
(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.sanger.ac.uk%2FInfo%2FPress%2Fgfx%2F030221_T_whipplei_300.jpg&hash=9972c634da597069d7db0bb9b91515f6)
http://www.sanger.ac.uk/Info/Press/gfx/030221_T_whipplei_300.jpg
YAYYYYYYYYYY! thanks Iko it is actually very interesting. So symptoms can range from nothing to tons of stuff! That must make diagnosing very difficult indeed!
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5.0 - Questions about Whipples in Medicine
5.1 - What is Whipple's Disease?
Whipple's disease is a multisystem disorder caused by chronic infection with a bacterium, Tropheryma whippelii. Many patients have malabsorption, which means an impairment of the body's ability to absorb certain nutrients. The disease frequently causes weight loss, irregular breakdown of carbohydrates and fats, resistance to insulin. Most patients have dysfunctions of the immune system. When recognized and treated, Whipple's disease can be cured. Untreated, the disease is usually fatal. Read more at the National Digestive Diseases Clearing House or at Whipple´s Disease Online.
Whipple's disease was named after George Hoyt Whipple, who first observed the disease in 1907 at Johns Hopkins University in Baltimore, Maryland. Whipple was a staff member there from 1905 until 1914. He won the 1934 Nobel Prize in physiology and medicine. (See Blaine Whipple's article on this site and George Hoyt Whipple's ancestry in the WhippleGenWeb.)
(This question was answered with the help of Dr. med. Axel von Herbay, Privatdozent für Pathologie, Pathologisches Institut, Universitätsklinikum, Im Neuenheimer Feld 220, 69120 Heidelberg, Germany. Dr. von Herbay can be reached by e-mail at Axel_von_Herbay@med.uni-heidelberg.de, on the Web at www.WhipplesDisease.net, by telephone at +49 6221 562675, or by fax at +49 6221 562675.)
from: http://www.whipple.org/docs/faqs.html#5.1
(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.biomedcentral.com%2Fcontent%2Ffigures%2F1472-6823-6-3-3-l.jpg&hash=e9cec600a73264e26915f8f758346e91)
http://www.biomedcentral.com/content/figures/1472-6823-6-3-3-l.jpg
full-text article on "Reversible Hypothyroidism...": http://www.biomedcentral.com/content/pdf/1472-6823-6-3.pdf
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I hope you now have got the 'basics' of Whipple Disease,
I will add many more links later, don't worry.
Everybody is invited to post whipple bits here.
The final story has to be written still.
Then we'll collect a series of abnormal presentations
of the very same disease...looking like something else!
Whipple's disease: a granulomatous masquerader.
James DG, Lipman MC.
Department of Medicine, Royal Free School of Medicine, Rowland Hill Street, London NW3 2PF, UK.
Whipple's disease is a multisystemic infection that affects middle-aged white men. It typically presents with fever, polyarthritis, diarrhea, steatorrhea, and weight loss.
Many other systems can be involved, however, including the central nervous system, heart, lymphatics, lungs, bone marrow, and skin. Recent work has demonstrated the causative organism to be a complex bacteria, Tropheryma whipplei. The diagnosis is established most securely by periodic acid-Schiff staining of foamy monocyte-macrophages in biopsy tissue and body fluids, by electron microscopy, which reveals bacilli within membrane-bound vesicles, and by molecular amplification techniques using polymerase chain reaction of tissues and body fluids. The differential diagnosis includes chronic multisystemic infections and granulomatous disorders, because Whipple's disease is a fascinating blend of both. The condition can resemble sarcoidosis and mycobacterial disease and fungal, protozoal, and bacillary infections. Earlier diagnosis leads to earlier treatment and hopefully the prevention of chronic disabling complications and needless mortality from this once uniformly fatal condition.
Clin Chest Med. 2002 Jun;23(2):513-9, xi-xii.
(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.2camels.com%2Fimages%2Ffestival-photos%2Fvenice-carnevale6.jpg&hash=20867921800d67d8d82f94dfebad0dcd)
http://www.2camels.com/images/festival-photos/venice-carnevale6.jpg
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Here is one of the most intriguing episodes of Whipple hunting:
the ultra-advanced treatment for a common disorder (Rheumatoid
Arthritis, or Still's disease) makes the real rare disease come OUT!
...and it's a report from Germany.
Exacerbation of Whipple's disease associated with infliximab treatment.
Kneitz C, Suerbaum S, Beer M, Müller J, Jahns R, Tony HP.
Department of Clinical Immunology and Rheumatology, Medizinische Poliklinik, University of Würzburg, Germany. kneitz_C@klinik.uni-wuerzburg.de
A 34-year-old man with chronic inflammatory joint disease and recurrent fever over 6 years was diagnosed as having Still's disease. Treatment with corticosteroids and azathioprine was ineffective. Therefore, infliximab/ methotrexate was started. The patient subsequently developed a wasting disease with rapid weight loss, erythema nodosum, diarrhoea, progressive lymph node enlargement, and a sigmoido-vesical fistula. Histological analysis of several enlarged lymph nodes, the margins of the fistula, and the small bowel established the diagnosis of Whipple's disease (WD). The presence of Tropheryma whipplei (Tw) DNA in the tissues was confirmed by polymerase chain reaction (PCR). Careful re-evaluation of biopsies taken from the ileum and the liver 2 years earlier, which at that time was not judged to be diagnostic for WD, retrospectively showed subtle histological signs of WD and were positive for Tw DNA.
In summary, infliximab treatment seems to increase the risk of exacerbation of WD.
WD should be carefully ruled out prior to application of tumour necrosis factor-alpha (TNF-alpha) blockade.
Scand J Rheumatol. 2005 Mar-Apr;34(2):148-51.
http://www.annals.org/cgi/content/full/126/3/214
http://cmr.asm.org/cgi/reprint/14/3/561
http://www.biomedcentral.com/content/pdf/1472-6823-6-3.pdf
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2003000300009
http://jnnp.bmj.com/cgi/content/abstract/73/3/336
http://stroke.ahajournals.org/cgi/content/abstract/31/8/2002
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=12701398&ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17258677&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
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Sorry, I just found a major whipple-website,
"the" thing to start safely from here:
it had been temporarily lost in my notes.
Ready to click and read.
Enjoy
http://www.whipplesdisease.net/
(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.whipplesdisease.net%2Fa_Whipple.jpg&hash=ab67ffde138be0a0d00613328d396026)
http://www.whipplesdisease.net/a_Whipple.jpg
http://gsm.about.com/pictures/photo_us/029/sulf008i.jpg
The treatment: Sulfamethoxazole; Trimethoprim, SMX-TMP Tablet (Tab 400;80 mg;mg) for 1-2 years.
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Before disappearing for a while and going again
through my messy notes about Whipple's disease,
I post another mysterious case for the affectionate
readers of 'fastidious' persistent infections:
here Whipple was dressed up as dermatomyositis,
an 'autoimmune' disorder of uncertain etiology...
...a pediatric case, quite rare indeed.
Actually it's easy: WD&DM give only this 1 citation on PubMed! [:D]
Dermatomyositis and Whipple's disease.
Helliwell TR, Appleton RE, Mapstone NC, Davidson J, Walsh KP.
Department of Pathology, University of Liverpool, UK.
A 14-year-old boy presented with a 3-year history of a skin rash typical of juvenile dermatomyositis, and a 2-month history of mild proximal weakness, myalgia, and weight loss. A quadriceps biopsy showed perifascicular fibre atrophy, focal necrosis and regeneration, immunohistochemical labelling for HLA-1 on the surface of the fibres, and focal C5-9 deposition in capillaries. Macrophages with diastase-resistant, PAS-positive cytoplasm were present. Ultrastructural studies showed electron dense and membranous debris. The patient's symptoms responded to intravenous immunoglobulin and oral prednisolone.
Four months after discontinuing prednisolone, the patient developed cardiac failure, ventricular tachycardia, and a recurrence of his rash. The 16S ribosomal RNA specific for Tropheryma whippelii was identified by polymerase chain reaction (PCR) analysis in skeletal and cardiac muscle. The myalgia and skin rash responded to prednisolone and oral co-trimoxazole, and the tachycardia is controlled by oral verapamil. This patient appears to have a novel association of juvenile dermatomyositis and Whipple's disease.
Neuromuscul Disord. 2000 Jan;10(1):46-51.
(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.virtualitalia.com%2Ftravel%2Fveneto_cold.gif&hash=bc2834b1ae4debf0ae3b11715fcb577c)
http://www.virtualitalia.com/travel/veneto_cold.gif
Even Toxoplasma gondii has been involved in
several cases of autoimmune dermatomyositis.
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Thanks Iko.. interesting reading indeed...Thank you...
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Early diagnosis of Whipple's disease is crucial to
lower the number of useless autoptic diagnoses.
This is one "just on time" case in point:
(USA, 10 years ago!)
Cardiac Whipple Disease: Identification of Whipple Bacillus
by Electron Microscopy in the Myocardium of a Patient before Death.
by Silvestry FE et al.
University of Pennsylvania Medical Center, Philadelphia, USA.
Ann Intern Med. 1997 Feb 1;126(3):214-6.
http://www.annals.org/cgi/content/full/126/3/214
Free full-text available!
(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.ecodibergamo.it%2FEcoOnLine%2FAssets%2FSPETTACOLO%2FATTORI_TEATRI_SPETTACOLI%2FBURATTINI%2Farlecchino--480x398.jpg&hash=45d4623df05b2659a90d4a66ccf8015a)
http://www.ecodibergamo.it/EcoOnLine/Assets/SPETTACOLO/ATTORI_TEATRI_SPETTACOLI/BURATTINI/arlecchino--480x398.jpg
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New patient-friendly technologies for Whipple's disease hunting:
fiberoptic endoscopy cannot inspect the entire small intestine,
but only the first part of it, called duodenum, and a bit further...
In some 'occult' cases, whipple bacteria may hide in unreachable
sites of the small intestine. Now they have to deal with micro-
electronics progress!
Refractory Whipple's disease with anaemia: first lessons from capsule endoscopy.
Fritscher-Ravens A, Swain CP, von Herbay A.Endoscopy Unit, St Mary's Hospital, London, UK.
Whipple's disease is a chronic multisystem disorder caused by infection with the rod-shaped bacterium, Tropheryma whippelii. We report the case of a 65-year-old woman with intestinal Whipple's disease that had been refractory to monotherapy with a number of antibiotics over a 2-year period. The patient then presented with watery diarrhoea, cachexia (body mass index 18 kg/m (2)) and chronic anaemia (haemoglobin 7.6 g/dl). Wireless capsule endoscopy showed that the disease affected the entire small intestine. Focal occult areas of bleeding were observed in different parts of the jejunum. The capsule's transit time through the small intestine was 2 hours 43 minutes. Capsule endoscopy allows novel insights into the pathophysiology of Whipple's disease.
Endoscopy. 2004 Jul;36(7):659-62.
(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fcomm.uea.ac.uk%2Fmind%2Fgetimg.asp%3Fid%3D256%26amp%3Bx%3D800%26amp%3By%3D800&hash=6e1adec73f2ac90e91469b11abca5a73) (https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.yalemedicalgroup.org%2Fnews%2Fimages%2Fproctor1.jpg&hash=c0092a5cd47191b271b1a8ad45dd048a) (https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.uihealthcare.com%2Fnews%2Fcurrents%2Fvol5issue1%2Fimages%2F5crohnsulcer3.jpg&hash=7d407b9812e03692464db84031805adf)
http://comm.uea.ac.uk/mind/getimg.asp?id=256&x=800&y=800
http://www.yalemedicalgroup.org/news/images/proctor1.jpg
http://www.uihealthcare.com/news/currents/vol5issue1/images/5crohnsulcer3.jpg
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Everything and its opposite, these are the 'typical' extremely vague symptoms
of Whipple disease according to clinical reports in medical literature.
As insomnia is rarely found, even hypersomnia has been recently reported:
Hypersomnia in Whipple disease: case report.
Maia LF, Marta M, Lopes V, Rocha N, Lopes C, Martins-da-Silva A, Monteiro L.
Department of Neurological Disordes and Senses, Hospital Geral de Santo António, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal.
Whipple disease (WD) is a rare systemic infection caused by Tropheryma whippelii. Neurological involvement has been recognised in 40% of patients, either as initial manifestations or during the course of the disease. We report on a 45 years-old man with WD with initial, persistent and irresistible episodes of daytime somnolence. The patient was HLA-DQB1*0602 positive (genetic marker for narcolepsy). WD diagnosis was suspected on clinical and MRI basis and confirmed by histological and immunohistochemical study of duodenal biopsy. Forty months later all clinical features improved, narcoleptic-like episodes disappeared and cerebral MRI and CSF normalised. Longitudinal neurophysiological studies revealed persistent sleep pattern abnormalities with sleep fragmentation, paucity of slow wave and of REM sleep. The disruption of the hypocretin circuitry in the hypothalamic - diencephalic region triggered by the infection was the probable cause of the hypersomnia and narcopleptic symptoms. WD should be added to the list of causes of secondary hypersomnia.
Arq Neuropsiquiatr. 2006 Sep;64(3B):865-8.
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Could you explain Hypersomnia better please?
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Could you explain Hypersomnia better please?
Sorry Karen,
I was sleeping! [;D]
Hypersomnia should be 'super'sleep, too much sleep and somnolence during daytime.
This patient had a genetic predisposition to narcolepsy too...
Well, narcolepsy is...(wiki-wiki-wiki! [;)])
Narcolepsy
Narcolepsy is a neurological condition most characterized by Excessive Daytime Sleepiness (EDS). A narcoleptic will most likely experience disturbed nocturnal sleep, confused with insomnia, and disorder of REM or rapid eye movement sleep. It is a type of dyssomnia.
The main characteristic of narcolepsy is overwhelming excessive daytime sleepiness (EDS), even after adequate night time sleep. A person with narcolepsy is likely to become drowsy or to fall asleep, often at inappropriate times and places. Daytime naps may occur with or without warning and may be physically irresistible. These naps can occur several times a day. They are typically refreshing, but only for a few hours. Drowsiness may persist for prolonged periods of time. In addition, night-time sleep may be fragmented with frequent awakenings.
Four other classic symptoms of narcolepsy, which may not occur in all patients, are cataplexy, sleep paralysis, hypnogogic hallucinations, and automatic behavior. Cataplexy is an episodic condition featuring loss of muscle function, ranging from slight weakness (such as limpness at the neck or knees, sagging facial muscles, or inability to speak clearly) to complete body collapse. Episodes may be triggered by sudden emotional reactions such as laughter, anger, surprise, or fear, and may last from a few seconds to several minutes. The person remains conscious throughout the episode. Sleep paralysis is the temporary inability to talk or move when waking up. It may last a few seconds to minutes. This is often frightening but is not dangerous. Hypnagogic hallucinations are vivid, often frightening, dream-like experiences that occur while dozing, falling asleep and/or while awakening. Automatic behavior means that a person continues to function (talking, putting things away, etc.) during sleep episodes, but awakens with no memory of performing such activities. It is estimated that up to 40 percent of people with narcolepsy experience automatic behavior during sleep episodes. Daytime sleepiness, sleep paralysis, and hypnagogic hallucinations also occur in people who do not have narcolepsy, more frequently in people who are suffering from extreme lack of sleep. Cataplexy is generally considered to be unique to narcolepsy.
from wikipedia: http://en.wikipedia.org/wiki/Narcolepsy
MyGoodness, me hope never get this narcoPEPSI! [:o]
...actually that seems to be a typical case of whipplesomnia...
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...other cases of whipplesomnia:
Insomnia for 5 years.
Lieb K, Maiwald M, Berger M, Voderholzer U.
Department of Psychiatry, University of Freiburg, Germany. klaus_lieb@psyalig.ukl.uni-freiburg.de
...no abstract available on PubMed Database.
you have to trust me: it was Whipple!
Lancet. 1999 Dec 4;354(9194):1966.
(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.carnivalofvenice.com%2FMediaGallery%2FGallery%2FEventi%2FCarnevale%2F2005%2FFEB01%2FAUT19058.JPG&hash=609c55816acb9df55745bee6bb861c96)
http://www.carnivalofvenice.com/MediaGallery/Gallery/Eventi/Carnevale/2005/FEB01/AUT19058.JPG
An unusual case of insomnia associated with Whipple encephalopathy: first case reported from Greece.
Papadopoulou M, Rentzos M, Vagiakis E, Zouvelou V, Potagas C, Bonakis A, Chatzipanagiotou S, Ioannidis A, Nicolaou C, Vassilopoulos D.Department of Neurology, University of Athens Medical School, Eginition Hospital, 74 Vas. Sophias Av., 11528, Athens, Greece. marpapgr@yahoo.co.uk
Whipple disease is a relapsing systemic illness caused by Tropheryma whippelii.
Central nervous system involvement occurs in 5%-40% of all patients. Hypothalamic manifestations occur in 31% of Whipple encephalopathy, including polydipsia, hyperphagia, change in libido and insomnia. We report a case of a 48-year-old man with severe insomnia, depression, dementia, dysarthria, myoclonic movements of the limbs and ophthalmoplegia. The diagnosis of Whipple encephalopathy was confirmed by PCR analysis of blood and faeces. He received a full dose of antibiotic treatment. Despite clinical improvement, resolution of the lesions detected in MRI scan of the brain and negative results of the PCR in blood, faeces and cerebrospinal fluid six months later, insomnia persisted and finally subsided after the administration of carbamazepine (600 mg/day). Our case supports the finding that carbamazepine might be useful in the treatment of insomnia associated with Whipple encephalopathy.
Neurol Sci. 2005 Jul;26(3):174-7.
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http://guide.dada.net/psicoterapia_ericksoniana/myimg/196435_1.jpg
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This time Whipple was dressed up as sarcoidosis,
a mysterious infectious-like granulomatous disorder
of uncertain etiology...but Tropheryma whippelii
had been hiding there for years.
Weight loss, joint pain and abdominal lymphadenopathy
as signs of sarcoidosis, but also of Whipple's disease [Article in Dutch]
Deeren D, Vanderschueren S, Ectors N, Blockmans D, Bobbaers H.
Afd. Interne Geneeskunde, Universitaire Ziekenhuizen Leuven, België. driesdeeren@hotmail.com
Two patients, a woman aged 66 and a man aged 56 years, with an inflammatory syndrome, weight loss, joint pain and abdominal lymphadenopathy received long-term treatment with corticosteroids for alleged sarcoidosis. No long-term remission was induced and the patients were referred for a second opinion. Eventually the diagnosis of Whipple's disease was established 5 years after the appearance of the first symptoms in the case of the female patient and 4 years after in the case of the male patient. Both patients showed a marked clinical improvement after treatment with trimethoprim-sulfamethoxazole.
An atypical presentation of alleged sarcoidosis should suggest the possibility of Whipple's disease, especially in the case of gastrointestinal symptoms and the failure to respond to corticosteroids, and warrants duodenal biopsy. The presence of granulomas with an elevated angiotensin-converting enzyme level is not pathognomonic for sarcoidosis. It is vitally important to distinguish the two disorders, as Whipple's disease is an infectious disorder that requires antibiotic therapy to prevent a fatal outcome.
Ned Tijdschr Geneeskd. 2003 Mar 29;147(13):620-4.
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http://www.carnevalevenezia.com/images/carnevale/maschere_piazza_san_marco_venezia.jpg
In this unfortunate case -several years ago- it was simply too late...
Chronic interstitial nephritis in Whipple's disease.
Schlumpf A, Marbet UA, Stöcklin E, Wegmann W, Lämmle B, Mujagic M, Jösch W, Thiel G, Thölen H, Olivieri W, Gudat F, Torhorst J, Zollinger HU, Mihatsch MJ.
Report is given on a 68-year-old man who suffered primarily from progressive weight loss and repeated episodes of fever and arthralgia.
Later, liver dysfunction and renal insufficiency developed. Liver and kidney biopsies disclosed granulomatous hepatitis and nephritis. Because of the morphologic and clinical findings, the diagnosis of Boeck's disease (sarcoidosis) was made. Shortly before death, diarrhea developed.
Autopsy revealed a massive systemic involvement in Whipple's disease proven by light and electron microscopy and immunofluorescence. Tuberculoid and epitheloid cell granulomas and isolated giant cells were found in addition to the biopsy findings in skeleton muscles, the small intestine, lymphnodes and bronchi. At autopsy, the kidney showed chronic interstitial nephritis. The literature of kidney involvement in Whipple's disease is reviewed. This is the first case with granulomatous interstitial nephritis and chronic renal insufficiency in an inadequately treated Whipple's disease.
Klin Wochenschr. 1983 Jan 3;61(1):25-33.
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Gosh this disease seems to be masquerading around as if it could be many different things ..I am glad I am not a doctor! LOL So confusing..
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Whipple was masked as meningoencephalitis in a young woman here.
Infectious etiology was suspected and PENICILLIN administered...
without finding any germ! But of course it worked -empirically- for
a few months.
Then Whipple came back as a severe cardiovascular problem, and
again managed to hide until a brain biopsy was performed.
A simple PCR test would have made it earlier and more safely.
(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.pimpo.com%2Fcarnevale%2Fvenezia.jpg&hash=85b372b4ce74515df0f8ad86f3ab1f84)
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Cerebral Whipple's disease with a stroke-like presentation and cerebrovascular pathology.
Peters G, du Plessis DG, Humphrey PR.
Department of Neurology, Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
Although neurological symptoms are common in Whipple's disease, patients rarely have a purely neurological presentation and involvement restricted to the central nervous system is uncommon. A 39 year old woman presented with a meningoencephalitic illness, which responded to penicillin.
Eleven months later she developed recurrent stroke-like episodes. Patchy enhancing meningeal, cortical, and subcortical lesions thought to be vascular in origin developed within nine days of the onset of symptoms. No evidence was found of a cardiovascular source of emboli, vasculitis, or thrombophilic condition. A brain biopsy showed meningoencephalitic features suspicious of Whipple's disease associated with leptomeningeal arterial fibrosis and thrombosis.
DNA polymerase chain reaction confirmed Tropheryma whippelii in both blood and brain tissue.
The neurological manifestations of cerebral Whipple's disease are varied and very rarely include stroke-like symptoms. The pathogenesis of cerebral infarction in Whipple's disease is not well established but arterial fibrosis and endocarditis complicated by embolisation have been reported. This case emphasises the importance of early brain biopsy in unusual cases of stroke and illustrates the clinical utility of polymerase chain reaction to confirm Whipple's disease.
J Neurol Neurosurg Psychiatry. 2002 Sep;73(3):336-9.
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Whipple disease is a very rare infection
mainly observed in middle-aged men and
only in some cases affecting the brain.
Statistically, of course.
But here there was a young boy and ONLY
the central nervous system was touched:
Presumed central nervous system Whipple's disease in a child: case report.
Tan TQ, Vogel H, Tharp BR, Carrol CL, Kaplan SL.
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Whipple's disease is a rare, chronic, multisystem illness that is pathologically characterized by the accumulation of macrophages in the involved tissue that have a positive periodic acid-Schiff reaction. It is typically seen in middle-aged white men, and only four cases involving persons younger than 15 years of age have been reported. CNS Whipple's disease without intestinal manifestations is rare; only six cases have been reported in the literature, all involving adults. We report the case of a young boy with clinical, laboratory, radiographic, and pathological signs and symptoms consistent with CNS Whipple's disease who responded to therapy with trimethoprimsulfamethoxazole.
Clin Infect Dis. 1995 Apr;20(4):883-9.
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http://www.dubrovnik-online.com/albums/album12/aaa.jpg
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Any comment, criticism, contribution?
While I'm here waiting, I post a new Carnival
in Venice picture that I've just grabbed...
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http://www.ssqq.com/halloween/images/venice%2001a.jpg
I love the pictures.. and Iko is this primarily a disease that strikes men, or do a number of women get it to, albeit rarely...
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Whipple disease is a very rare infection
mainly observed in middle-aged men and
only in some cases affecting the brain.
Statistically, of course.
Mostly middle-aged men, and until few years ago proper diagnostic tools were lacking.
Consequently abnormal presentations, like brain involvement without gastrointestinal symptoms (diarrhea), arthralgia, fever and wasting were probably overlooked.
Since the development of Polymerase Chain Reaction (PCR) genetic techniques, major progress has been achieved in this field: incredibly abnormal presentations are being discovered and reported more and more frequently, and normal people hosting the germ identified (healthy carriers are not uncommon).
As in many other medical issues, the final story has still to be written.
My genuine interest as a 'reader', as you probably understood, is about whipple disease overlapping with mysterious 'autoimmune' disorders. Finally an infectious cause for a group of ailments that are frequently supposed to be simply based on an immune disorder, our defence system attacking its own territory. And treated by immune suppression, that shouldn't be the case when a 'fastidious' pathogen is fussying around.
Cheers
ikod
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Hummm I see maybe a young boy, but No women?? Why do you suppose?
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Hummm I see maybe a young boy, but No women?? Why do you suppose?
Hey,
I'm not going to report and copy ALL whipple cases from MedLine!
But if you check the previous abstracts, you'll find women too...
In autoimmune disorders women win 10 to one, approximately.
Immune systems -is suggested- are heavily controlled by sex hormones.
We should ask Chris about Whipple naughty beasts...
he doesn't seem interested, or he's just too busy right now.
May be he had a very bad Carnival in Venice! [;D]
Take care
ikod
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http://images.jupiterimages.com/common/detail/83/47/22684783.jpg
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Hummm I see maybe a young boy, but No women?? Why do you suppose?
Hey,
I'm not going to report and copy ALL whipple cases in MedLine!
But if you check the previous abstracts, you'll find women too...
In autoimmune disorders women win 10 to one, approximately.
Immune systems -is suggested- are heavily controlled by sex hormones.
We should ask Chris about Whipple naughty beasts...
he doesn't seem interested, or he's just too busy right now.
May be he had a very bad Carnival in Venice! [;D]
Take care
ikod
I did not expect you to make copies silly! LOL..HEE HEE. I did not know I missed it in the previous posts so I will look back again.. Thank's Iko.
Hey you might be right I forgot Chris was going on that trip! I do hope he had lots of fun. It sounded lovely!
Do you mean ask him about the fastedious bugs you spoke of to me when you are talking about this? "We should ask Chris about Whipple naughty beasts...
he doesn't seem interested, or he's just too busy right now" Are those the same ones you refer to that can get into your heart??
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Do you mean ask him about the fastedious bugs you spoke of to me when you are talking about this? "We should ask Chris about Whipple naughty beasts...
he doesn't seem interested, or he's just too busy right now" Are those the same ones you refer to that can get into your heart??
Me no catch this: too difficult 4me.
Say it in italian!
ikodfused [:(]
-
Do you mean ask him about the fastedious bugs you spoke of to me when you are talking about this? "We should ask Chris about Whipple naughty beasts...
he doesn't seem interested, or he's just too busy right now" Are those the same ones you refer to that can get into your heart??
Me no catch this: too difficult 4me.
Say it in italian!
ikodfused [:(]
It's OK Iko I am confused to a lot lately.. don't pay any attention to that post as I can't figure it out either..! LOL! Only slept for 3 hours felt like 3 minutes.... I have re read it and think I was thinking that the infectious bugs that can get into your heart heart might they be one and the same as in Whipples disease?? I think that is what I was asking.. LOL That still sounds wrong.. HEE HEE HEE.. Oh well!
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When Tropheryma whippelii hits the central nervous system only,
this great masquerader becomes almost an 'invisible' pathogen:
Reversal of dementia associated with Whipple's disease
by trimethoprim-sulfamethoxazole, drugs that penetrate the blood-brain barrier.
Ryser RJ, Locksley RM, Eng SC, Dobbins WO, Schoenknecht FD, Rubin CE.
A previously healthy 67-yr-old man presented with progressive dementia over an 11-mo period. Evaluation revealed evidence of malabsorption. Jejunal biopsy established the diagnosis of Whipple's disease. No other etiology for the patient's dementia was uncovered. Treatment with trimethoprim-sulfamethoxazole resulted in rapid elimination of Whipple's bacilli from the jejunum and complete reversal of the patient's dementia over a 6-mo period. Significant levels of trimethoprim and sulfamethoxazole were easily quantitated in the cerebrospinal fluid during therapy. There is increasing recognition of progressive neurologic disease in patients with Whipple's disease who were treated with tetracycline. The reversal of presumed central nervous system disease in this case suggests that drugs that penetrate the blood-brain barrier might be preferable for the initial treatment of Whipple's disease.
Gastroenterology. 1984 Apr;86(4):745-52.
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No Picture Iko...
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Cerebral Whipple's disease as a cause of reversible dementia.
Rossi T, Haghighipour R, Haghighi M, Paolini S, Scarpino O.
Unità Operativa di Neurologia, Ospedale Geriatrico Sestilli, I.N.R.C.A., Ancona, Italy. t.rossi@inrca.it
We describe a case of reversible dementia caused by Tropheryma whippelii (TW). Diagnosis was confirmed by a positive polymerase chain reaction for this pathogen both on serum and cerebrospinal fluid. Specific antibiotic therapy resulted in distinct clinical and neuroradiological improvement. Control polymerase chain reaction for T. whippelii on serum and cerebrospinal fluid was negative.
Clin Neurol Neurosurg. 2005 Apr;107(3):258-61.
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A prospective study of reversible dementias:
frequency, causes, clinical profile and results of treatment.
Srikanth S, Nagaraja AV.
Dementia Programme, Department of Neurology, Singapore General Hospital. drssrikanth@rediffmail.com
BACKGROUND: Dementia due to potentially reversible etiologies is an important group of dementias to be identified not only because of the number of such Patients encountered but also due to the potential for substantial improvement with treatment.
AIMS: To prospectively investigate the frequency and causes of dementias with potentially reversible etiologies; to examine the clinical features of this subgroup with a view to identifying a signature profile and to determine if this potential reversibility translates into actual reversibility with appropriate treatment. SETTING AND DESIGN: A prospective longitudinal study of patients with dementia presenting to the outpatient services of a tertiary referral hospital. Methods: All Patients above 40 years referred for evaluation of cognitive complaints were serially enrolled and underwent clinical examination, various laboratory tests and neuroimaging. Patients were followed-up for one year.
STATISTICAL ANALYSIS: One way analysis of variance for continuous variables followed by post hoc comparisons using Scheffe's procedure.
RESULTS: A total of 129 patients met Diagnostic and Statistical Manual of Mental Disorders edition 4 (DSM IV) criteria for dementia and qualified for inclusion into the study. Twenty-four patients (18%), all with moderately severe cognitive [mean mini mental state examination (MMSE) score +/- SD = 17.9 +/- 4.8] and neuropsychiatric [mean neuropsychiatric inventory (NPI) score +/- SD = 30.7 +/- 8.7] dysfunction were diagnosed to have reversible causes - neuroinfections in 11 patients, normal pressure hydrocephalus in 8 patients and vitamin B12 deficiency in 5 patients. The majority of these patients had gait and urinary dysfunction reminiscent of subcortical dementias. These reversible causes were clinically suspected in only 58% of patients. In 20/24 patients in whom follow up was possible mean MMSE score had improved to 22.2 and mean NPI score had improved to 8.0, following 6 months of treatment.
CONCLUSIONS: Reversible causes, especially neuroinfections and vitamin B12 deficiency accounted for 18% all dementias in this study.
The majority of these conditions was not clinically suspected though resulting in moderate to severe cognitive and psychiatric dysfunction. Most of these patients had a subcortical pattern of dementia and showed substantial improvement with treatment.
Neurol India. 2005 Sep;53(3):291-4; discussion 294-6.
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It looked like a lymphoma, but under the microscope
an infection was diagnosed: Whipple's disease!
Abdominal lymphomas, convulsive seizure and coma: a case of
successfully treated, advanced Whipple's disease with cerebral involvement.
Mohm J, Naumann R, Schuler U, Ehninger G.
Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Germany.
Whipple's disease is a rare, generalized inflammatory disorder due to the recently described bacterium Tropheryma whippelii. We report an unusual, successfully treated case of a 32-year-old woman, who presented with a 25 month history of large abdominal lymphomas, polyserositis and cachexia. The diagnosis of Whipple's disease was confirmed by duodenoscopy, lymph node and duodenal histology and polymerase chain reaction analysis of biopsy material and cerebrospinal fluid. A prolonged convulsive seizure with a subsequent 5 day period of coma were interpreted as signs of cerebral involvement. Under antibiotic treatment with trimethoprim-sulfamethoxazole (co-trimoxazole) the patient recovered completely, CT scans showed a complete regression of abdominal lymphomas. The therapy was continued over 18 months without the occurrence of a relapse.
Eur J Gastroenterol Hepatol. 1998 Oct;10(10):893-5.
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One of many Whipple-websites is from Ohio Health:
everything is well explained and easy to find...
http://www.doctorshospital.org/bodymayo.cfm?xyzpdqabc=0&id=6&action=detail&ref=2896&hr=Healthy%20Living&topic=Life%20Stages&subtopic=Adult
...even diagnostic difficulties are smartly described:
Screening and diagnosis
Whipple's disease is rare and many doctors may be unfamiliar with the disorder, so it's often diagnosed in its late stages. However, the earlier the diagnosis, the better because of the serious health risks associated with nontreatment.
(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.connecticutlifescience.com%2Fbiohistory_images%2Fwhipple.jpg&hash=5322b57be6a4edf17fd8935f0c2048d8)
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George Hoyt Whipple, a graduate of Yale University (A.B. 1900), was awarded the 1934 Nobel Prize for Physiology or Medicine with George R. Minot and William P. Murphy for their discoveries concerning liver therapy in cases of anaemia. (Photo: © The Nobel Foundation)
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For a neglected issue like this
1000 viewers
is a good reason to celebrate...
ikod [^]
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Do you mean ask him about the fastedious bugs you spoke of to me when you are talking about this? "We should ask Chris about Whipple naughty beasts...
he doesn't seem interested, or he's just too busy right now" Are those the same ones you refer to that can get into your heart??
Me no catch this: too difficult 4me.
Say it in italian!
ikodfused [:(]
It's OK Iko I am confused to a lot lately.. don't pay any attention to that post as I can't figure it out either..! LOL! Only slept for 3 hours felt like 3 minutes.... I have re read it and think I was thinking that the infectious bugs that can get into your heart heart might they be one and the same as in Whipples disease?? I think that is what I was asking.. LOL That still sounds wrong.. HEE HEE HEE.. Oh well!
Hi Karen!
I took an extra boost of vitamin hyper megadoses and finally got your point!
Yes, Whipple bacteria can affect the heart and its valves, giving subacute endocarditis, strokes and things...but very rarely -because it is a very rare disease- and in the same fashion as many other much more common germs.
Some studies suggest that Whipple bacteria cause less inflammation than the other germs in most of the cases, but this is not clear (like all the rest).
ikod
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Whipple's endocarditis: review of the literature
and comparisons with Q fever, Bartonella infection, and blood culture-positive endocarditis.
Fenollar F, Lepidi H, Raoult D.
Unité des Rickettsies, Centre Nationale de Recherche Scientifique, Unité Mixte de Recherche 6020, Marseille, France.
Whipple's disease is a systemic infection sometimes associated with cardiac manifestations. Recently, there has been an increase in the number of reported cases of Whipple's endocarditis. The purpose of our study was to describe this entity. Data from 35 well-described cases of Whipple's endocarditis were collected and compared with those of blood culture-positive endocarditis, Q fever endocarditis, and Bartonella endocarditis. Some patients with generalized Whipple's disease presented with cardiac involvement, among other symptoms. Others presented with a nonspecific, blood culture-negative endocarditis with no associated symptoms. In comparison with cases of endocarditis due to other causes, congestive heart failure, fever, and previous valvular disease were less frequently observed in the cases of Whipple's endocarditis. Without examination of the excised valves, the diagnosis of infective endocarditis could not have been confirmed in most cases. Treatment is not well established. Whipple's endocarditis is a specific entity involving minor inflammatory reactions and negative blood cultures, and its incidence is probably underestimated.
Clin Infect Dis. 2001 Oct 15;33(8):1309-16.
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Whipple's disease: a difficult diagnosis?
Peters FP, Elbrecht EA, Wouters RS, Engels LG, Stockbrügger RW.
Department of Gastroenterology, University Hospital Maastricht, Netherlands.
We present 3 patients with Whipple's disease all characterized by a longstanding prodromal period with progressive weight loss, diarrhoea, lymphadenitis and arthralgia or arthritis. Sarcoid-like Whipple's disease was diagnosed in one patient. He was treated with antibiotics. Initially his condition improved; however, a cerebral relapse developed which was treated successfully by ceftriaxone and cefixime. Extraintestinal Whipple's disease (lymph node localisation) was diagnosed in another patient treated successfully with antibiotics. A third case of Whipple's disease was unexpectedly diagnosed by laparotomy and partial small bowel resection. He was not treated till 2 years later with tetracycline. After 1 year of treatment his condition had improved.
Neth J Med. 1996 Sep;49(3):106-11.
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That is very interesting Iko!I LOVE THESE PICTURES!!!!
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Wrong diagnosis for 16yrs,
then diarrhea started, so
Whipple was suspected and
...FOUND RIGHT THERE!!!
(17yrs ago)
Whipple's disease with axial and peripheral joint destruction.
Scheib JS, Quinet RJ.
Department of Internal Medicine, Ochsner Clinic, New Orleans, La.
A seropositive white man had follow-up for 16 years with a diagnosis of palindromic rheumatism. Treatment had included parenteral gold, methotrexate, prednisone, hydroxychloroquine sulfate, and penicillamine before diarrhea led to a biopsy-proven diagnosis of Whipple's disease.
Clinical and radiographic criteria for ankylosing spondylitis were met. In addition to classic Whipple's arthropathy, he had the combined but singular findings of pancarpal destruction and cervical apophyseal fusion. HLA typing revealed the B7 antigen. This case illustrates the pitfalls in diagnosis of a chronic polyarthritis that has, as a typical feature, a long latency before manifesting its more specific signs and symptoms (ie, diarrhea, malabsorption, and hyperpigmentation). Care should be taken during evaluation of any disease with atypical and nonspecific features (eg, positive rheumatoid factor in a patient with polyarthritis) and one should continue to reevaluate the original impression while confirmatory evidence is lacking. Moreover, the roentgenographic findings of pancarpal narrowing, apophyseal fusion, and advanced iliofemoral joint disease, in addition to sacroiliitis and syndesmophyte formation, challenge the generally held notion that Whipple's arthropathy is a nondestructive joint disease.
South Med J. 1990 Jun;83(6):684-7.
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iko,
First, let me say thank you to you for your insight and thoughts on Tropheryma whipplei bacteria.
A good friend of mine has recently begun treatment consistent with that for Whipple's disease.
After reading a bit on this bacteria and the Whipple's disease, I have come to believe that it is considered to be rare only because it is so difficult to observe.
Also, I am curious about a few potential issues relating to this bacteria:
- Is this bacteria is able to be passed from one person to another by becoming airborne?
- Has any researcher actually ever seen this bacteria alive, since an electron microscope does not allow for live viewing?
- If not, how does this restrict the effort of researchers to understand the nature of this bacteria?
- Could many, many diseases that are presently known to the medical community be simply manifestations of different stages of this bacteria's existence within its human host and be incorrectly viewed as stand alone diseases?
- Are some or all of the bacteria in the family of this bacteria being underestimated in terms of their ability to work together?
- Can evolutionary change to any of the (six?) bacteria in this family allow a systematic evolution from one to another to another ... and ultimately to the T whipelii?
- Is it possible that this bacteria plays a very substantial role in cancer diseases?
- Do you think that routine efforts to check for this bacteria and further understand the likelihood of its role in medical conditions listed on the following website as soon as a few of these symptoms are recognized (http://www.mayoclinic.com/health/whipples-disease/DS00757/DSECTION=2) would help to substantially increase advanced detection of this bacteria, prevent more advanced illnesses and deaths, and thus save the medical industry money?
- Do you believe that until this bacteria is dressed up in threads of economics and globally paraded before the medical insurance industry as a profit thief that that industry will continue to underestimate it or overlook it?
Thank you again for your insight and for your devotion to this subject.
I look forward to seeing what your responses to these questions are.
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Dear understudy,
thank you so much for joining us
in this whipply discussion.
I'll reply your multiple questions asap!
For now I suggest not to focus on one single germ
causing many diseases, but on MANY different 'fastidious'
germs causing troubles in few predisposed individuals: this is the
mainframe of this whipple experiment here.
I'm not an expert: sometimes it helps! [;D]
Cheers,
ikod
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OK understudy,
I'll reply your multiple questions as
a no-expert, just your discussant and
a simple 'reader' of intriguing cases
regarding obnoxious fastidious germs.
iko,
First, let me say thank you to you for your insight and thoughts on Tropheryma whipplei bacteria.
A good friend of mine has recently begun treatment consistent with that for Whipple's disease.
After reading a bit on this bacteria and the Whipple's disease, I have come to believe that it is considered to be rare only because it is so difficult to observe.
I think Tropheryma whipplei may be a common germ in our environment, nevertheless it causes troubles in very few people. Even considering a consistent number of undiagnosed cases, it should be a rare pathogen anyway.
I overstressed on purpose intriguing reports from medical literature to open the discussion on how to find a cheap and easy way to avoid these treatable ailments go undetected for months and years, with all the human suffering involved.
Also, I am curious about a few potential issues relating to this bacteria:
- Is this bacteria is able to be passed from one person to another by becoming airborne?
I think it survives happily in the environment (Actinomycetae) with its triple layer membrane, consequently air, dust, water and contacts may be the routes of infection.
As in many other cases, infection is routinely kept under control efficiently by the defence systems: only in rare instances -probably because of some immune defect- whipple bacteria manage to spread around.
See the previously cited reviews for details.
- Has any researcher actually ever seen this bacteria alive, since an electron microscope does not allow for live viewing?
Interesting point: Whipple bacteria had been successfully cultured at the end of the last century. They are intracellular germs...I think it's quite difficult to see them alive.
- If not, how does this restrict the effort of researchers to understand the nature of this bacteria?
- Could many, many diseases that are presently known to the medical community be simply manifestations of different stages of this bacteria's existence within its human host and be incorrectly viewed as stand alone diseases?
Good point, and the actual target of this thread, but never forget that this could be just one of several germs playing dirty tricks and hiding behind some 'idiopathic' human diseases.
I decided to start with this peculiar one knowing that it's not alone.
- Are some or all of the bacteria in the family of this bacteria being underestimated in terms of their ability to work together?
- Can evolutionary change to any of the (six?) bacteria in this family allow a systematic evolution from one to another to another ... and ultimately to the T whipelii?
I'd like to be able to answer these questions! [:-X]
- Is it possible that this bacteria plays a very substantial role in cancer diseases?
We cannot exclude it, if we accept the connection between persistent infection, chronic inflammation and cancerogenesis. Helicobacter pylori causes intestinal lymphomas and gastric cancer.
- Do you think that routine efforts to check for this bacteria and further understand the likelihood of its role in medical conditions listed on the following website as soon as a few of these symptoms are recognized (http://www.mayoclinic.com/health/whipples-disease/DS00757/DSECTION=2) would help to substantially increase advanced detection of this bacteria, prevent more advanced illnesses and deaths, and thus save the medical industry money?
Give me some time to check this out...
- Do you believe that until this bacteria is dressed up in threads of economics and globally paraded before the medical insurance industry as a profit thief that that industry will continue to underestimate it or overlook it?
Sometimes peculiar issues and rare disorders are ignored just like that: I would not always search for a hidden negative influence by medical insurance industry or others.
I tend to think that we need many more new smart brains most of all, honest enthusiastic researchers. I've met many, maybe we need more.
Medical research about fastidious persistent germs could be partly supported by our govs and independent foundations. Major pharmaceutical companies will follow
Thank you again for your insight and for your devotion to this subject.
I look forward to seeing what your responses to these questions are.
Thank you so much for your difficult questions:
I apologize right away for my short replies...
I prefer synthetic and condensed communication.
Regards,
ikod
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I overstressed on purpose intriguing reports from medical literature to open the discussion on how to find a cheap and easy way to avoid these treatable ailments going undetected for months and years, with all the human suffering involved.
In a few words, modern PCR technology will eventually allow us -in the near future- to develop special inexpensive microchips to detect by one simple blood test most of the germs that we carry 'on board'.
An infectious disease will be diagnosed in seconds starting from the germ this time, not from patients' medical history, signs and symptoms.
Quite a little revolution in clinical medicine, but today we do already use other 'screening' tests.
Of course we'll need top notch sensitivity and the highest number of bugs searched through a single test, to make it reliable, easy and cheap.
Unfortunately, these days we see some of this magic hightech show used mostly in forensic medicine.
ikodnotes [^]
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http://images.the-scientist.com/content/figures/0890-3670-050411-44-1-1.jpg
http://www.five.tv/media/image/11970633.jpg
The Bug
What is it?
Where is it found?
How is it transmitted?
What diseases does it cause?
Who/what is at risk of infection?
click here for free full-text!
http://microbiology.mtsinai.on.ca/bug/TW/tw-bug.shtml
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iko,
Thank you very much for your responses to my questions.
Kindly take notice of some relatively new findings regarding previous studies on the prevalence of Tropheryma whipplei in certain populations.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1890548
If this new study is accurate, then how does this affect the widely held belief that for those testing positive for the Tropheryma whipplei bacteria in their saliva that the bacteria itself is less responsible for disease than a defect in one's immune system or individual immunity to Tropheryma whipplei? <<<<<<<this is the key question here!
Previous estimates have suggested that as many as 40% of the population carry Tropheryma whipplei in their saliva, and that only a small percentage of those testing positive for it have Whipple's disease - or one of the accepted forms of it.
Is it possible that the methods used in the new study could still have overlooked additional false positives, despite greatly reducing the prevalence of Trpheryma whipplei in the general population?
Am I misreading the data or are as much as 80% of the positives reviewed, in this May 2007 study, "false positives?"
Thank you again for your time and effort.
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iko,
Thank you very much for your responses to my questions.
Kindly take notice of some relatively new findings regarding previous studies on the prevalence of Tropheryma whipplei in certain populations.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1890548
If this new study is accurate, then how does this affect the widely held belief that for those testing positive for the Tropheryma whipplei bacteria in their saliva that the bacteria itself is less responsible for disease than a defect in one's immune system or individual immunity to Tropheryma whipplei? <<<<<<<this is the key question here!
Previous estimates have suggested that as many as 40% of the population carry Tropheryma whipplei in their saliva, and that only a small percentage of those testing positive for it have Whipple's disease - or one of the accepted forms of it.
Is it possible that the methods used in the new study could still have overlooked additional false positives, despite greatly reducing the prevalence of Trpheryma whipplei in the general population?
Am I misreading the data or are as much as 80% of the positives reviewed, in this May 2007 study, "false positives?"
Thank you again for your time and effort.
Thanks for your help overstudy! [;D]
This contribution of yours shows us how fragile is our so called 'evidence' sometime.
Whipple bacteria are not anymore so common in humans as previously stated and we have to wait for properly arranged studies to know the percentage of 'healthy carriers' in our population.
We wanted to play the Helicobacter pylori game with Whipple too: common germ and few affected patients. No, this time is going to be different and maybe more complicated.
Of course, this is Whipple, the great granulomatous masquerader!
ikod [;)]
(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.teatrozircone.com%2Fmaschere.jpg&hash=0865187d2a7a3a6892e5576dfe2b1e3e)
http://www.teatrozircone.com/maschere.jpg
Still, impo*, we urgently need a cheap and reliable routine laboratory test for patients.
*) in my personal opinion
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iko,
Welcome back.
To celebrate your return, I'll ask a new question.
Do parasites co-exist with "Tropheryma whipplei" in human hosts?
Just asking.
Thank you so much, again.
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Hi understudy,
I took a couple of weeks off in fact.
Now I'm back to the Whipplipedia forum!
Thank you for your precious support around here.
Parasites, defined as protozoa (Toxoplasma, Giardia, Amoebas etc.) or multicellular (Nematoda, Cestoda) like pinworms, surely may coexist in any patient affected by any bacterial infection, so supposedly even in Whipple disease.
In certain countries, people don't carry just one, but 2 or 3 different species of parasites per person, due to the precarious hygienic standards.
I don't remember a single case report of whipple disease and any parasitic infestation of sort.
That doesn't certainly mean that there aren't any!
Why are you interested in such a peculiar association?
Do you suspect an immune deficiency in WD patients?
Bacterial infections swich on different immune reactions.
Common bacteria stimulate antibody production and macrophages' appetite.
Intracellular (e.g. TB, WD) bacteria need a macrophage and T-Lymph more complex response.
Parasites and fungi as well require a T-Lymph compartment fully operative.
As you probably read before, years ago a slightly defective T-cell subset has been suspected to contribute to Whipple disease...but these data need confirmation, like those PCR results! [;D]
ikoD
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iko,
Sorry for my delay in responding.
Do most symptoms for a person suffering from parasites mimic those of a person suffering from a classic case of Whipple's disease?
Once antibiotic treatment for classic Whipple's disease is ongoing, should routine blood analysis show histaminase and basophils reacting as though one is being treated for parasites?
Are these just overlapping symptoms and reactions?
Thank you again.
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iko,
Sorry for my delay in responding.
Do most symptoms for a person suffering from parasites mimic those of a person suffering from a classic case of Whipple's disease?
There are many different species of parasites and they cause a wide variety of symptoms, so the 'classic' presentation of Whipple's disease, diarrhea-fever-weightloss-anemia and joint pain may overlap a parasite infestation.
Anyway, parasites are carefully searched in any severe case of diarrhea.
Once antibiotic treatment for classic Whipple's disease is ongoing, should routine blood analysis show histaminase and basophils reacting as though one is being treated for parasites?
I cannot answer this question.
WD bacteria duplication time is very long: approx. 18days.
When you start antibiotic therapy bacteria don't die in a short time, and for this reason treatment has to be extended (at least one year).
Are these just overlapping symptoms and reactions?
Thank you again.
If you consider the previously reported cases, you'll find that WD may be misdiagnosed as rheumatoid arthritis or dermatomyositis, as sarcoidosis or even non-Hodgkin lymphoma.
In rare cases WD has been discovered as the unsuspected cause of reversible dementia.
Whipple's disease has never been reported misdiagnosed as a parasite infestation.
Parasitic diseases are diagnosed by specific tests: it's easy to rule them out.
One exception could be intracellular protozoa like Toxoplasma and Babesia, but this is another story...
This is the aim of this thread: difficult diagnosis and -maybe in rare cases- the 'real' cause of diseases of uncertain(!) etiology.
ikod [^]
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iko,
Let me thank you so much for your compelling response.
Intracellular parasitic infestation never misdiagnosed as a Whipple's disease?
It appears that "another story" is little understood and rapidly changing, even if intracellular parasites and Tropheryma Whipplei are mutually exclusive, which remains to be "seen."
Again, thank you for your fine work.
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iko,
Let me thank you so much for your compelling response.
Intracellular parasitic infestation never misdiagnosed as a Whipple's disease?
It appears that "another story" is little understood and rapidly changing, even if intracellular parasites and Tropheryma Whipplei are mutually exclusive, which remains to be "seen."
Again, thank you for your fine work.
Good point understudy,
I assume that a coexistent pathogen should have been spotted easily.
WD bacteria are so tiny that electron microscopy is required to make a sure diagnosis and visualize those peculiar 'three layer' cell walls.
Any protozoa, even the intracellular ones (i.e. Toxoplasma gondii) are so big compared to the invisible Tropheryma whipplei.
In my opinion, for some reason, in most cases one pathogen tend to prevail, and other germs are probably kept under control by the patient's aspecific immune reaction, that is loosing its battle against WD only.
I know that several infectious agents can damage a patient simultaneously when immune defense is jammed (i.e. AIDS), but very exceptionally in the so called 'immunocompetent' host.
We must cosider that when you give a WD patient Bactrim for at least one year, even many other germs may suffer!
I am afraid I am not a qualified expert, able to cover this issue properly.
ikod
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Ola whipple amigos,
Allow me to re-post this intriguing whipple report from Australia:
http://www.biomedcentral.com/content/pdf/1472-6823-6-3.pdf
it's free full-text, instant access online, easy text and nice pictures...
This is a unique report concerning thyroid damage by WD.
Nevertheless no bacteria was found in the thyroid itself!
Enjoy the reading if you missed my previous link in page 1 of this topic.
ikod [^]
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WOW i did miss this. Very good Article Long article but very good information.. well How about that IKO! That sounds promising for people with thyroid Goiters with worry so much about all the other stuff on top of it! LOL... Nice article I think I will print it! LOL Or at least the link!
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Wait Karen,
this is an extremely rare presentation.
It may serve as a model for the current hypothesis
hidden pathogen - persistent infection - autoimmune disease.
Many other common germs could play the same trick just like our dear Tropheryma w.
ikod [^]
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Wait Karen,
this is an extremely rare presentation.
It may serve as a model for the current hypothesis
hidden pathogen - persistent infection - autoimmune disease.
Many other common germs could play the same trick just like our dear Tropheryma w.
ikod [^]
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http://images.the-scientist.com/supplements/20070501/images/37-1.gif
So there may be other germs that could cause this same presentation you mean perhaps not only the T w.. . I remember that Bartonellos(spelling, sorry) and Q fever .. could be a source also right!
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What kind of disease is Addisons? Is it an auto immune disease?
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Would you explain autoimmunity to me a little bit better? I am not sure I get it! Are auto immune diseases ones that break down our immune systems ability to fight off infections and such?
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What kind of disease is Addisons? Is it an auto immune disease?
Primary Addison's disease is a severe failure of adrenal glands and following stop of secretion of vital steroid hormones. Potentially fatal if untreated.
Sometimes it is caused by infection, other times by metastatic cancers or autoimmune reaction.
There is a recent topic right here about this:
http://www.thenakedscientists.com/forum/index.php?topic=10216.0
Definition of autoimmunity:
A situation in which the body produces an immune response against its own organs or tissues.
www.biotech.ca/EN/glossary.html
an immune reaction to the body's own tissues.
www.shortbowel.com/glossary/a.asp
A condition in which the body's immune system fights it's own tissues.
www.spacecoastmedicalassociates.com/terms/
A condition characterized by a specific antibody (antiphospholipid antibody or antibodies to DNA) or cells (such as Natural Killer Cells) which react with molecules or constituents of the body's own tissue and cause disease such as Rheumatoid arthritis and lupus.
repro-med.net/glossary.php
a condition in which an individual’s immune system starts reacting against one’s own tissues, causing disease.
www.oup.com/uk/booksites/content/0199264724/student/glossary.htm
A condition in which the immune system produces antibodies against the body's own proteins or tissues. This may result in an autoimmune disease such as lupus, type 1 diabetes, rheumatoid arthritis, or multiple sclerosis.
www.beyondpsoriasis.com/glossary.jsp
Immune-mediated destruction of the body's own cells and tissues; immunity against self.
www.dental.mu.edu/oralpath/opgloss.html
...plus many others!
We better start a new topic for such a wide and complex issue.
Actually I do not think I will be able to discuss it properly.
ikod
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Better to go back to intriguing presentations of
Whipple's disease in human beings on this Planet.
Here there is a quite recent report from China:
Diffuse cortical lesions with hemorrhage in cerebral Whipple's disease.
Wu L, Wang X, Wei H, Li C, Jia J.
Department of Neurology, Xuanwu Hospital, Capital University of Medical Sciences, Beijing 100053, PR China.
A 30-year-old Chinese male with a history of diarrhea and arthralgia presented for evaluation of progressive dementia, epilepsy, and increased intracranial pressure. Imaging of the brain showed progressive cortical and subcortical lesions with hemorrhage involving the bilateral temporal and occipital lobes, the posterior parietal lobes, and the left frontal lobe. "Foamy" periodic acid-Schiff (PAS)-positive macrophages were demonstrated on brain biopsy. The patient showed clinical improvement following treatment with chloromycetin and sulfadiazine for 2 months.
This constitutes the first reported case of cerebral Whipple's disease with diffuse cortical lesions with hemorrhage reported in a Chinese individual. Further, this case points out the significance of early recognition and treatment of cerebral Whipple's disease, especially in those cases with unusual manifestations.
Clin Neurol Neurosurg. 2007 Oct 6;
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http://www.stylophilesonline.com/archive/jan03/05omas6.jpg
Whipple's disease.
Panicker JN, Vijayaraghavan L, Madhusudanan S.
Department of Medicine, Medical College, Thiruvananthapuram, Kerala.
A 52 year old lady was admitted for progressive pedal oedema over a six year period and recent onset of hyperpigmentation. Laboratory investigations revealed that she was having a malabsorption syndrome with protein losing enteropathy. In view of associated arthralgia and higher mental function disturbances, a clinical diagnosis of Whipple's disease was postulated. Duodenal biopsy revealed infiltration of the lamina propria with PAS positive macrophages, suggestive of Whipple's disease. This case is being reported to highlight that Whipple's disease can manifest in the most unsuspecting manner and that early treatment can cure the patient.
J Assoc Physicians India. 2001 Aug;49:853-5.
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(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.hamptons.com%2Fgallery%2Farticles%2F952c.jpg&hash=bc629e2d13cf80b2a483fd57224cc70f)(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.hamptons.com%2Fgallery%2Farticles%2F952c.jpg&hash=bc629e2d13cf80b2a483fd57224cc70f)(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.hamptons.com%2Fgallery%2Farticles%2F952c.jpg&hash=bc629e2d13cf80b2a483fd57224cc70f)
http://www.hamptons.com/gallery/articles/952c.jpg
For a neglected issue like this
over 3000 viewers
3 good reasons to celebrate...
ikod [^]
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Thanks Iko... Love the fireworks!
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Talking about strangest presentations!
Orbital manifestation of whipple's disease: An atypical case.
Lieger O, Otto S, Clemetson IA, Arnold M, Iizuka T.
Department of Cranio-Maxillofacial Surgery, University of Bern, Switzerland (Director and Head: Professor Tateyuki Iizuka, MD, DDS, PhD, FEBOMFS).
BACKGROUND: Whipple's disease is a systemic disorder caused by an infection with a gram-positive bacillus, Tropheryma whipplei. Almost every organ system can be affected in Whipple's disease, resulting in varying clinical symptoms.
CASE REPORT: As far as we are aware, this report of a 61-year-old male is the first presenting with a periorbital manifestation of the disease, with severe exophthalmos and optic nerve involvement, leading to rapid visual loss.
This emergency case was successfully treated by a surgical orbital decompression combined with systemic use of antibiotics and steroids.
CONCLUSION: Whipple's disease can affect the periorbital tissues and the optic nerve, causing massive exophthalmos and serious transient visual loss. In such a case surgical decompression of the affected orbit combined with antibiotics and steroids is a recommended valid treatment option.
J Craniomaxillofac Surg. 2007 Oct 26;
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http://itp.nyu.edu/projects_documents/1145268301_E_bye_E.jpg
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Does Whipples ever effect vision by making you have Blurred vision..? Kind of garbled up for short periods of time. I am talking like 4 or 5 minutes then poof gone back to normal!
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Yes Karen,
like several other more common infectious agents,
even Whipple bacteria may cause optic neuritis,
i.e. inflammation of the eye nerve, our TV cable...
Nevertheless, scattered episodes of blurred vision are quite
common and in many cases totally benign, certainly not a
specific symptom of an hidden infectious disease.
Here is a report of blurred vision in neuroborreliosis:
Motion-onset and pattern-reversal visual evoked potentials in diagnostics of neuroborreliosis.
Kubová Z, Szanyi J, Langrová J, Kremlácek J, Kuba M, Honegr K.
Department of Pathophysiology, Charles University in Prague, Faculty of Medicine in Hradec Králové, Czech Republic. kubova@lfhk.cuni.cz
Neuroborreliosis is a form of borreliosis that affects the central and/or peripheral nervous system. Although it can mimic neurologic and ophthalmologic disorders such as multiple sclerosis and optic neuritis, visual evoked potential (VEP) examination is usually not used in neuroborreliosis diagnostics. Combined VEP testing (pattern-reversal VEPs and VEPs produced in response to linear and radial motion) was performed in 81 patients with neuroborreliosis verified by laboratory results (positive polymerase chain reaction or intrathecal antibodies production). Thirty-four patients reported diplopia or blurred vision related to borreliosis. In 33 (40%) patients the VEPs were delayed: motion-onset VEPs were pathologic in 22 (27%) patients, reversal VEPs in 5 (6%) patients, and both VEP types in 6 (7%) patients. The findings suggest that VEP testing (especially the motion-onset VEP testing) can confirm CNS involvement. Much higher sensitivity of motion-onset VEPs in comparison with reversal VEPs can result from rather selective (earlier) involvement of the magnocellular system or the dorsal stream of the visual pathway.
J Clin Neurophysiol. 2006 Oct;23(5):416-20.
Nonpathologic Causes of Blurred Vision
Refractive Errors
Functional Loss of Vision
Pathologic Causes of Blurred Vision
Sudden, Unilateral, Painless Loss of Vision
Sudden, Unilateral, Painful Loss of Vision
Sudden, Bilateral, Painless Loss of Vision
Sudden, Bilateral, Painful Loss of Vision
Gradual, Unilateral, Painless Loss of Vision
Gradual, Unilateral, Painful Loss of Vision
Gradual, Bilateral, Painless Loss of Vision
Gradual, Bilateral, Painful Loss of Vision
Conclusions
Source Information
From Ophthalmic Consultants of Boston, Boston.
Address reprint requests to Dr. Shingleton at 50 Staniford St., Suite 600, Boston, MA 02114, or at bjshingleton@eyeboston.com
source: NEJMed. http://content.nejm.org/cgi/content/short/343/8/556
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When typical symptoms of Whipple disease
like diarrhea, malabsorption, anemia are
missing...to diagnose it is very hard:
Whipple's disease with muscle impairment.
Puget M, Iwaz J, Tristan A, Streichenberger N.Department of Internal Medicine, Centre Hospitalier Lyon-Sud, 165 Chemin du Grand Revoyet, 69495 Pierre-Bénite, France. mpuget@ch-valence.fr
A 67-year-old man presented with myalgia, muscle atrophy, and a history of seronegative polyarthritis. Blood tests showed inflammation but no hematologic or immunologic abnormalities. Muscle biopsy revealed no vasculitis or myositis but Tropheryma whipplei was detected by polymerase chain reaction in muscle, blood, and duodenum specimens; this was confirmed by immunohistochemistry. Ceftriaxone led to clinical improvement. Although rare, Whipple's disease should be considered in the differential diagnosis of diffuse myopathy.
Muscle Nerve. 2006 Dec;34(6):794-8.
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http://www.terragalleria.com/images/italy/ital7126.jpeg
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Autoptic cases.
At the end of this topic,
to never forget that a consistent
number of whipple-diagnoses are still...
...autoptic. Unfortunately.
Whipple Disease: A Case Report and Review of the Literature
MAJ Jeannie Muir-Padilla, COL Jerome B. Myers.
Department of Pathology, Madigan Army Medical Center, Tacoma, Wash.
Archives of Pathology and Laboratory Medicine: 2005:129, No. 7, pp. 933–936.
...
A 62-year-old woman presented to her primary care physician complaining of worsening shortness of breath. The patient's past medical history included restrictive cardiomyopathy of unknown etiology, sick sinus syndrome with pacemaker placement, congestive heart failure, arthritis, hepatomegaly, spontaneous bacterial peritonitis, intermittent diarrhea, and hypothyroidism.
Physical examination revealed a febrile woman with mild venous jugular distension, bilateral diffuse crackles in the lower and mid lung fields, and a distended abdomen with guarding and a positive fluid wave.
Examination of the peritoneal fluid revealed 4+ neutrophils with no bacteria. The patient was treated with furosemide for her diagnosis of congestive heart failure and appropriate antibiotic therapy for spontaneous bacterial peritonitis. She was discharged on hospital day 8 after showing improvement in her oxygenation status. Four days after discharge from the hospital, the patient again complained of difficulty breathing. Emergency medical personnel were summoned, and the patient was found apneic and pulseless with perioral cyanosis. Based on the previously documented wishes of the patient, resuscitative measures were not undertaken, and the patient was pronounced dead.
...
free full-text available on line:
http://arpa.allenpress.com/arpaonline/?request=get-document&doi=10.1043%2F1543-2165(2005)129%5B933:WDACRA%5D2.0.CO%3B2
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Wow Iko...I am being treated with the same medication.Furosemide 40 mg tabs, seems to be common treatment They also have me on the Trimeterine/HCTZ 37.5/25 caps.. Blood Pressure and diuretic.
[quote/] (Iko)A 62-year-old woman presented to her primary care physician complaining of worsening shortness of breath. The patient's past medical history included restrictive cardiomyopathy of unknown etiology, sick sinus syndrome with pacemaker placement, congestive heart failure, arthritis, hepatomegaly, spontaneous bacterial peritonitis, intermittent diarrhea, and hypothyroidism.[quote}
These all sound way too familiar...
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Wow Iko...I am being treated with the same medication.Furosemide 40 mg tabs, seems to be common treatment They also have me on the Trimeterine/HCTZ 37.5/25 caps.. Blood Pressure and diuretic.
(Iko)A 62-year-old woman presented to her primary care physician complaining of worsening shortness of breath. The patient's past medical history included restrictive cardiomyopathy of unknown etiology, sick sinus syndrome with pacemaker placement, congestive heart failure, arthritis, hepatomegaly, spontaneous bacterial peritonitis, intermittent diarrhea, and hypothyroidism.
These all sound way too familiar...
Hi Karen,
please don't improvise: too many diseases give that picture!
This is actually an example of atypical presentation...
BTW are you taking any antibiotic?
ikod
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[size=07pt]
(sorry Iko.. I accidently put my post in yours, all fixed..)[/size]
No worries I won't I don't want to even guess at anything.. I want them just to figure out what it is that is really wrong and stop just treating symptoms..It is really frustrating...
I tried to go for my appointment this last week and they delayed it due to care provider problems.. they were having some staff turnover and rescheduled me for the 29th unless she can slip me into an earlier spot then we will start. So far no antibiotics for the infection... I must say.. Have been feeling crudy and having a hard time taking full breaths.. The coughing has become much worse with lots of clear fluid when it allows it to come up.. some times the cough is just unproductive and dry. Chest hurts when I try to breathe in a normal breath. Yesterday was coughing so Hard My head felt like something popped a couple inches down into the center. That has happened a couple times.. OOOOH sorry I am rambling ... no antibiotics as of yet!
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February 2008 Whipple update:
less invasive diagnostic tools are coming!
Advances in Tropheryma whipplei research:
the rush to find biomarkers for Whipple's disease.
Kowalczewska M, Raoult D.
Unité des Rickettsies, CNRS UMR 6020, IFR 48, Faculté de Médecine, 27 Bd Jean Moulin, 13385 Marseille, France. kmalgo@yahoo.fr
Whipple's disease (WD) is a systemic chronic infection, caused by the Gram-positive bacterium Tropheryma whipplei. There are several clinical traits linked to WD: histological lesions in the GI tract in association with diverse clinical manifestations (classic WD), endocarditis with negative blood cultures, and isolated neurological infection. WD is rare, predominantly affects middle-aged men and is fatal without treatment. The most recent strategy for diagnosing WD uses the results of diastase-resistant periodic acid Schiff staining and PCR in parallel, both performed on involved organ/tissue biopsy (small intestine, cardiac valve and cerebrospinal fluid). The generation of rabbit polyclonal antibodies has enabled the detection of the bacterium in tissues by immunohistochemical staining. However, the diagnosis of WD remains an invasive procedure. The recent achievement of stable bacterial culture and sequencing of the T. whipplei genome has opened a framework for the development of a biomarker platform. Several studies in different fields have been performed, for example, transcriptomics, immunoproteomics and comparative proteomics. Biomarker candidates have been proposed for the development of less invasive procedures for diagnosing WD.
Future Microbiol. 2007 Dec;2:631-42.
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Prosthetic hip infection caused by Tropheryma whipplei. (http://www.ncbi.nlm.nih.gov/pubmed/18287323)
"We report a case of prosthetic hip infection due to Tropheryma whipplei in a 74-year-old man not previously known to have Whipple's disease. Diagnosis was based on systematic 16S rRNA gene amplification and sequencing of samples obtained during revision hip arthroplasty."
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Scattered reports allow including WD between
the infectious causes of hip arthritis:
"Hipple Disease" [;D]
Whipple's disease diagnosed at hip arthroplasty.
Farr M, Hollywell CA, Morris CJ, Struthers GR, Bacon PA, Walton KW.
A patient is reported with a six-year history of seronegative inflammatory arthritis, lymphadenopathy, and a rash. Many investigations, including repeat jejunal and synovial needle biopsies, failed to establish the diagnosis. Eventually right hip destruction led to arthroplasty. Synovial membrane obtained at operation was examined by electron microscopy and organisms were found with the morphological characteristics of those in patients where the diagnosis was firmly established as Whipple's disease. We propose that Whipple's disease should be seriously considered as a rare but distinct and treatable possibility in the differential diagnosis of seronegative inflammatory arthritis.
Ann Rheum Dis. 1984 Jun;43(3):526-9.
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Recent news from the official Whipple-beasts hunting experts:
Prevalence of asymptomatic Tropheryma whipplei carriage among humans and nonhuman primates.
Fenollar F, Trani M, Davoust B, Salle B, Birg ML, Rolain JM, Raoult D.
Université de la Méditerranée, Unité des Rickettsies, CNRS UMR 6020, Faculté de Médecine, Marseille cedex, France.
BACKGROUND: The reservoir of the agent of Whipple disease is unknown. Asymptomatic carriage of Tropheryma whipplei in human stool and saliva is controversial. METHODS: Stools and saliva specimens from 231 workers at a sewage treatment facility and from 10 patients with Whipple disease, stool specimens from 102 healthy people, and stool specimens from 127 monkeys or apes were tested for T. whipplei DNA by a quantitative real-time polymerase chain reaction with probe detection. Genotyping and culture of T. whipplei-positive samples were performed. RESULTS: Asymptomatic carriage in stool was found in humans (ranging from a prevalence of 4% in the control group to 12% among a subgroup of sewer workers) but not in monkeys and apes. The T. whipplei load in stool was significantly lower in carriers than in patients with Whipple disease (P < .001). There was a significant prevalence gradient associated with employment responsibilities at the sewage treatment facility: workers who cleaned the underground portion of the sewers were more likely than other workers to carry T. whipplei in stool. Seven of 9 sewer workers tested positive 8 months later. Patients with Whipple disease were significantly more likely to have T. whipplei-positive saliva specimens (P = .005) and had a significantly greater T. whipplei load in saliva (P = .015), compared with asymptomatic stool carriers from the sewage facility. All non-stool carriers had T. whipplei-negative saliva specimens. T. whipplei strains were heterogeneic among sewer workers but identical within individual workers.
CONCLUSION: Chronic asymptomatic carriage of T. whipplei occurs in humans. Bacterial loads are lower in asymptomatic carriers, and the prevalence of carriage increases with exposure to sewage.
J Infect Dis. 2008 Mar 15;197(6):880-7.
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http://www.genomenewsnetwork.org/articles/03_03/whipple_art.shtml
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Something so beautiful can be so nasty... what a shame!
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June 2008 update:
most intriguing cases from...Italy!
Mammamia!
Whipple Disease: Unusual Presentation of a Protean and Sometimes Confusing Disease.
Lo Monaco A, Govoni M, Zelante A, Rinaldi R, Scorrano AR, Di Stefano M, Trotta F.Dipartimento di Medicina Clinica e Sperimentale, Sezione di Reumatologia-Università di Ferrara, Ferrara, Italy.
OBJECTIVES: To describe an unusual case of Whipple disease (WD) with confusing clinical features at onset and to discuss the diagnostic challenges for the clinician. METHODS: Description of a new case of this rare disease and thorough discussion of the atypical clinical manifestations at onset. A literature review, concerning the unusual onset, by means of a MEDLINE search from 1966 to 2007 was done.
RESULTS: A 39-year-old man with sudden bilateral blurred vision due to retinal vasculitis and concomitant rapidly evolving symmetrical neurosensory bilateral hearing loss as initial features of WD is described. Due to the clinical manifestations resembling systemic vasculitis, high-dose corticosteroid and pulse cyclophosphamide therapy were started with subsequent appearance of gastrointestinal symptoms (diarrhea and weight loss) and spiking fever, suggesting superimposed infection. After a complete evaluation, including gastroscopy, extensive duodenal-jejunal mucosal involvement was seen, while diffuse infiltration of the duodenal lamina propria with periodic acid-Schiff-positive foamy macrophages was observed on the histological sample. The diagnosis was confirmed by reverse transcriptase-polymerase chain reaction for the DNA of Tropheryma whippelii. To our knowledge, no previous similar clinical onset of WD has been described.
CONCLUSIONS: To avoid misdiagnosis and therapeutic mistakes, clinicians should be aware of unusual presentations of WD. Because this etiological agent is a difficult to isolate bacterium, diagnosis may be especially problematic in cases without intestinal involvement at onset.
Semin Arthritis Rheum. 2008 Jun 5. [Epub ahead of print]
(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.ferrara.biz%2Fferrara.jpg&hash=935ad5082123e25e3182422631aec61c)
http://www.ferrara.biz/ferrara.jpg
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Hey Iko.. I have been reading and reading this entire thread again, and throughout the thread there is reference to: polymerase chain reaction. I was wondering if you could take few minutes and explain this procedure to me, and exactly what it is and how they run the test or how it works...?
Also in the last post I see the 1rst reference to: reverse transcriptase-polymerase chain reaction for the DNA of Tropheryma whippelii...
If it had been used in previous posts I missed it. I am curious about both..?
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Hi Karen,
Polymerase chain reaction allows you to find DNA or RNA from viruses or bacteria that hide somewhere in our body.
It is highly sensitive (few 'copies' of DNA/mL spotted easily) and very specific: special 'primers' used to start the reaction stick only to a particular sequence of DNAbases...
http://highered.mcgraw-hill.com/olc/dl/120078/micro15.swf
The big thing is that -to confirm an infectious disease- we don't rely anymore only on antibody production by the host, antibodies that might be absent or a memory of a previous infection: we look for bits and pieces of the very germs that came on board. Even searching for bugs in biopsies by microscope is difficult and messy(aggressive) enough...particularly in the case of intracellular germs like T.whipplei.
BTW, you may consider reverse-transcriptase part of the PCR test itself...same thing to spot and amplify little bits of nucleic acids, million copies that become 'visible' in the end, allowing a diagnosis of infection.
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Thank you IKO and thanks for the link.. I read your post and will now take a look at that link...
Thanks again..
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nice illustration IKO! Thanks for the link...
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Where can I get a PCR test for WD?
I am in Ontario Canada.
Also does it work on regular blood test, or does it have to come from the intestine?
Great thread IKO, I don't know how you keep finding these case reports, I can't find them anywhere but here!