[iko (OP)]

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.

http://www.dubrovnik-online.com/albums/album12/aaa.jpg

[Karen W.]

Any comment, criticism, contribution?
While I'm here waiting, I post a new Carnival
in Venice picture that I've just grabbed...

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...

[iko (OP)]

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

[Karen W.]

Hummm  I see maybe a young boy, but No women?? Why do you suppose?

[iko (OP)]

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!  []
Take care

ikod

http://images.jupiterimages.com/common/detail/83/47/22684783.jpg

[Karen W.]

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!  []
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??

[iko (OP)]

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  []

[Karen W.]

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!

[iko (OP)]

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.

http://www.unspecial.org/uns604/UNS_604_F44-01.jpg

[Karen W.]

No Picture Iko...

[iko (OP)]

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.

http://www.teatrozircone.com/maschere.jpg

[iko (OP)]

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.

http://www.psychicsahar.com/artman/uploads/venice-angie-medium_001.jpg

[iko (OP)]

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.

http://photography.nationalgeographic.com/staticfiles/NGS/Global/ApplicationAssets/img/enlarge.gif

[iko (OP)]

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.

http://www.connecticutlifescience.com/biohistory_images/whipple.jpg


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)

[iko (OP)]

http://www.hamptons.com/gallery/articles/952c.jpg

For a neglected issue like this
1000 viewers
is a good reason to celebrate...

ikod  [^]

[iko (OP)]

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

[iko (OP)]

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(:1309-16.

http://news.xinhuanet.com/english/2007-02/15/xinsrc_39202041510502032853422.jpg

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.

[Karen W.]

That is very interesting Iko!I LOVE THESE PICTURES!!!!

[iko (OP)]

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.

http://www.ee.duke.edu/~drsmith/cloaking/invisible_man.jpg

[understudy]

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 ( newbielink:http://www.mayoclinic.com/health/whipples-disease/DS00757/DSECTION=2 [nonactive]) 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.