Tropheryma whipplei - Revision history

Aidan: /* Classic Whipple Disease */

2023-05-04T17:52:55Z

Classic Whipple Disease

← Older revision		Revision as of 17:52, 4 May 2023
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	**Malabsorption may lead to hypoalbuminemia, peripheral edema, and ascites		**Malabsorption may lead to hypoalbuminemia, peripheral edema, and ascites
	*Also common are fevers (45%), myalgias (25%), lymphadenopathy (45%) (mainly mesenteric or mediastinal with non-caseating granulomas)		*Also common are fevers (45%), myalgias (25%), lymphadenopathy (45%) (mainly mesenteric or mediastinal with non-caseating granulomas)
	*Bloodwork shows anemia (81%), leukocytosis ~~948~~%), thrombocytosis (56%), and elevated [[CRP]] (69%)		*Bloodwork shows anemia (81%), leukocytosis (48%), thrombocytosis (56%), and elevated [[CRP]] (69%)

	=== Transient Whipple Disease ===		=== Transient Whipple Disease ===

Aidan: /* Diagnosis */

2023-01-12T17:10:57Z

Diagnosis

← Older revision		Revision as of 17:10, 12 January 2023
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	**Two different positive tests (PAS, PCR, or IHC) on a single sample		**Two different positive tests (PAS, PCR, or IHC) on a single sample
	**One positive test (PAS, PCR, or IHC) on two different samples		**One positive test (PAS, PCR, or IHC) on two different samples
			*In Canada, [https://cnphi.canada.ca/gts/reference-diagnostic-test/5435?labId=1006 PCR is done at the NML]

	==Management==		==Management==

Aidan at 19:29, 17 April 2022

2022-04-17T19:29:39Z

@@ Line 10: / Line 10: @@
 **Can be found in saliva of one third of healthy people
 *Disease is more common in white European (98%) males (85%)
-*Farming or occupational soil/animal exposures are commone
+*Farming or occupational soil/animal/sewage exposures are common
 ===Pathophysiology===
@@ Line 20: / Line 21: @@
 ===Classic Whipple Disease===
-*Cardinal features include: [[arthralgias]], followed by [[weight loss]], [[diarrhea]], and [[abdominal pain]]
+*Cardinal features include: [[arthralgias]] (80%), followed by [[weight loss]] (90%), [[diarrhea]] (75%), and [[abdominal pain]] (60%)
 *Arthralgias are typically migratory in the larger peripheral joints, including knees, ankles, and wrists, but can have essentially any presentation
-**May be present for years before development of other symptoms
+**May be present for up to 6 years before development of other symptoms
 *The diarrhea is intermittent, with colicky abdominal pain
 **Diarrhea can be watery or have steatorrhea
-**Occasional GI bleeding
+**Occasional GI bleeding (25%)
 === Transient Whipple Disease ===
@@ Line 65: / Line 71: @@
 ==Diagnosis==
-*Samples should be taken from involved sites, with a strong preference for small bowel biopsy if there are GI symptoms, but also synovial or cerebrospinal fluid or heart valve
+*Samples should be taken from involved sites, with a strong preference for small bowel biopsy if there are GI symptoms
-**Up to 7 to 10 biopsies from small bowel, ideally
+**At least 5, and ideally up to 7 to 10, biopsies from small bowel
 ==Management==
 *Generally treat with parenteral [[Is treated by::ceftriaxone]] 2 g IV daily or [[Is treated by::penicillin]] 2 MU IV q4h for 2 weeks (classic) or 4 weeks (endocarditis or CNS disease), followed by [[TMP-SMX]] DS PO bid for at least 1 year
 **Treatment can precipitate a [[Jarisch-Herxheimer reaction]]
@@ Line 79: / Line 89: @@
 **Other options include [[meropenem]], [[doxycycline]], [[macrolides]], [[ketolides]], [[aminoglycosides]], [[rifampin]], [[teicoplanin]], and [[chloramphenicol]]
 *Consider repeating small bowel biopsies annually for a few years
 ==Prognosis==

Aidan: Text replacement - "[[Cellular shape::" to "[[Shape::"

2020-10-15T04:29:28Z

Text replacement - "[[Cellular shape::" to "[[Shape::"

← Older revision		Revision as of 04:29, 15 October 2020
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	===Microbiology===		===Microbiology===

	*Fastidious [[Stain::Gram-positive]] [[~~Cellular shape~~::bacillus]]		*Fastidious [[Stain::Gram-positive]] [[Shape::bacillus]]

	===Epidemiology===		===Epidemiology===

Aidan at 17:07, 14 September 2020

2020-09-14T17:07:35Z

← Older revision		Revision as of 17:07, 14 September 2020
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	==Clinical Manifestations==		==Clinical Manifestations==

	===Classic Whipple's Disease===		===Classic Whipple Disease===

	*Cardinal features include: [[arthralgias]], followed by [[weight loss]], [[diarrhea]], and [[abdominal pain]]		*Cardinal features include: [[arthralgias]], followed by [[weight loss]], [[diarrhea]], and [[abdominal pain]]
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	**Diarrhea can be watery or have steatorrhea		**Diarrhea can be watery or have steatorrhea
	**Occasional GI bleeding		**Occasional GI bleeding

			=== Transient Whipple Disease ===

			* Transient, acute presentation of fever and diarrhea
			* Occurs mainly in children in Africa

			=== Asymptomatic Whipple Disease ===

			* Asymptomatic carriage of the bacterium, more common in sewage workers

			=== Localised Whipple Disease ===

			* Causes localised [[culture-negative endocarditis]] or CNS infection without systemic systems
			* Very difficult to diagnose

	===Other Symptoms===		===Other Symptoms===
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	*[[Anemia]] in 80%, [[leukocytosis]] in 50%, [[thrombocytosis]] in 50%		*[[Anemia]] in 80%, [[leukocytosis]] in 50%, [[thrombocytosis]] in 50%
	*Elevated C-reactive protein in 70%		*Elevated C-reactive protein in 70%

			=== Immunosuppression ===

			* Likely related to reactivation of latent infection, often in the context of [[HIV]] and [[IRIS]]
			* Can present with any of the above syndromes

	==Diagnosis==		==Diagnosis==
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	==Management==		==Management==

	*Generally treat with parenteral [[Is treated by::ceftriaxone]] 2 g IV daily or [[Is treated by::penicillin]] 2 MU IV q4h for 2 weeks followed by [[TMP-SMX]] DS PO bid for 1 year		*Generally treat with parenteral [[Is treated by::ceftriaxone]] 2 g IV daily or [[Is treated by::penicillin]] 2 MU IV q4h for 2 weeks (classic) or 4 weeks (endocarditis or CNS disease), followed by [[TMP-SMX]] DS PO bid for at least 1 year
	**Treatment can precipitate a [[Jarisch-Herxheimer reaction]]		**Treatment can precipitate a [[Jarisch-Herxheimer reaction]]
	**May also see [[immune reconstitution inflammatory syndrome]] in early treatment		**May also see [[immune reconstitution inflammatory syndrome]] in early treatment
	*Other options include [[meropenem]], [[doxycycline]], [[macrolides]], [[ketolides]], [[aminoglycosides]], [[rifampin]], [[teicoplanin]], and [[chloramphenicol]]		**Other options include [[meropenem]], [[doxycycline]], [[macrolides]], [[ketolides]], [[aminoglycosides]], [[rifampin]], [[teicoplanin]], and [[chloramphenicol]]
	*Consider repeating small bowel biopsies annually for a few years		*Consider repeating small bowel biopsies annually for a few years

Aidan: /* Epidemiology */

2020-08-03T02:30:21Z

Epidemiology

← Older revision		Revision as of 02:30, 3 August 2020
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	== Background ==		==Background==

	=== Microbiology ===		===Microbiology===

	* Fastidious [[Stain::Gram-positive]] [[Cellular shape::bacillus]]		*Fastidious [[Stain::Gram-positive]] [[Cellular shape::bacillus]]

	=== Epidemiology ===		===Epidemiology===

	* Ubiquitous environmental organism, but rarely causes disease		*Ubiquitous environmental organism, but rarely causes disease with only about 12 new cases diagnosed annually worldwide
	** Can be found in saliva of one third of healthy people		**Can be found in saliva of one third of healthy people
	* Disease is more common in white European males		*Disease is more common in white European (98%) males (85%)
			*Farming or occupational soil/animal exposures are commone

	=== Pathophysiology ===		===Pathophysiology===

	* Lack of host immune response		*Lack of host immune response

	== Clinical Manifestations ==		==Clinical Manifestations==

	=== Classic Whipple's Disease ===		===Classic Whipple's Disease===

	* Cardinal features include: [[arthralgias]], followed by [[weight loss]], [[diarrhea]], and [[abdominal pain]]		*Cardinal features include: [[arthralgias]], followed by [[weight loss]], [[diarrhea]], and [[abdominal pain]]
	* Arthralgias are typically migratory in the larger peripheral joints, including knees, ankles, and wrists, but can have essentially any presentation		*Arthralgias are typically migratory in the larger peripheral joints, including knees, ankles, and wrists, but can have essentially any presentation
			**May be present for years before development of other symptoms
	* The diarrhea is intermittent, with colicky abdominal pain		*The diarrhea is intermittent, with colicky abdominal pain
	** Diarrhea can be watery or have steatorrhea		**Diarrhea can be watery or have steatorrhea
	** Occasional GI bleeding		**Occasional GI bleeding

	=== Other Symptoms ===		===Other Symptoms===

	* Fever in 25 to 40%		*Fever in 25 to 40%
	* Lymphadenopathy, mostly of mesenteric and mediastinal nodes		*Lymphadenopathy, mostly of mesenteric and mediastinal nodes
	* CNS disease		*CNS disease
	** [[Dementia]], [[supranuclear ophthalmoplegia]], [[nystagmus]], and [[myoclonus]]		**[[Dementia]], [[supranuclear ophthalmoplegia]], [[nystagmus]], and [[myoclonus]]
	** [[Oculomasticatory myorhythmia]] and [[oculo-facial-skeletal myorhythmia]] with a supranuclear vertical gaze palsy		**[[Oculomasticatory myorhythmia]] and [[oculo-facial-skeletal myorhythmia]] with a supranuclear vertical gaze palsy
	** [[Cerebellar ataxia]]		**[[Cerebellar ataxia]]
	** Symptoms can occur with disease or as a post-treatment relapse		**Symptoms can occur with disease or as a post-treatment relapse
	* Cardiac disease		*Cardiac disease
	** Culture-negative [[endocarditis]], [[pericarditis]], and [[myocarditis]]		**Culture-negative [[endocarditis]], [[pericarditis]], and [[myocarditis]]
	** Endocarditis may occur on its own without other features of disease		**Endocarditis may occur on its own without other features of disease
	* Skin hyperpigmentation in 40%		*Skin hyperpigmentation in 40%
	* [[Pleural effusion]], [[chronic cough]], [[interstitial lung disease]], [[pulmonary hypertension]]		*[[Pleural effusion]], [[chronic cough]], [[interstitial lung disease]], [[pulmonary hypertension]]
	* [[Anemia]] in 80%, [[leukocytosis]] in 50%, [[thrombocytosis]] in 50%		*[[Anemia]] in 80%, [[leukocytosis]] in 50%, [[thrombocytosis]] in 50%
	* Elevated C-reactive protein in 70%		*Elevated C-reactive protein in 70%

	== Diagnosis ==		==Diagnosis==

	* Samples should be taken from involved sites, with a strong preference for small bowel biopsy if there are GI symptoms, but also synovial or cerebrospinal fluid or heart valve		*Samples should be taken from involved sites, with a strong preference for small bowel biopsy if there are GI symptoms, but also synovial or cerebrospinal fluid or heart valve
	** Up to 7 to 10 biopsies from small bowel, ideally		**Up to 7 to 10 biopsies from small bowel, ideally
	* Diagnosis is based on:		*Diagnosis is based on:
	** Periodic acid-Schiff-positive bacilli in macrophages		**Periodic acid-Schiff-positive bacilli in macrophages
	** PCR		**PCR
	** Immunohistochemistry		**Immunohistochemistry

	== Management ==		==Management==

	* Generally treat with parenteral [[Is treated by::ceftriaxone]] 2 g IV daily or [[Is treated by::penicillin]] 2 MU IV q4h for 2 weeks followed by [[TMP-SMX]] DS PO bid for 1 year		*Generally treat with parenteral [[Is treated by::ceftriaxone]] 2 g IV daily or [[Is treated by::penicillin]] 2 MU IV q4h for 2 weeks followed by [[TMP-SMX]] DS PO bid for 1 year
	** Treatment can precipitate a [[Jarisch-Herxheimer reaction]]		**Treatment can precipitate a [[Jarisch-Herxheimer reaction]]
	** May also see [[immune reconstitution inflammatory syndrome]] in early treatment		**May also see [[immune reconstitution inflammatory syndrome]] in early treatment
	* Other options include [[meropenem]], [[doxycycline]], [[macrolides]], [[ketolides]], [[aminoglycosides]], [[rifampin]], [[teicoplanin]], and [[chloramphenicol]]		*Other options include [[meropenem]], [[doxycycline]], [[macrolides]], [[ketolides]], [[aminoglycosides]], [[rifampin]], [[teicoplanin]], and [[chloramphenicol]]
	* Consider repeating small bowel biopsies annually for a few years		*Consider repeating small bowel biopsies annually for a few years

	== Prognosis ==		==Prognosis==

	* Clinical improvement takes 1 to 3 weeks of treatment		*Clinical improvement takes 1 to 3 weeks of treatment
	* Neurologic sequelae may be permanent		*Neurologic sequelae may be permanent
	* Relapses after treatment, including of CNS disease, can happen in up to a third of patients		*Relapses after treatment, including of CNS disease, can happen in up to a third of patients

	{{DISPLAYTITLE:''Tropheryma whipplei''}}		{{DISPLAYTITLE:''Tropheryma whipplei''}}

Aidan at 02:09, 3 August 2020

2020-08-03T02:09:55Z

← Older revision		Revision as of 02:09, 3 August 2020
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	* Neurologic sequelae may be permanent		* Neurologic sequelae may be permanent
	* Relapses after treatment, including of CNS disease, can happen in up to a third of patients		* Relapses after treatment, including of CNS disease, can happen in up to a third of patients

			{{DISPLAYTITLE:''Tropheryma whipplei''}}

	[[Category:Infectious diseases]]		[[Category:Infectious diseases]]

Aidan: Created page with "== Background == === Microbiology === * Fastidious Stain::Gram-positive Cellular shape::bacillus === Epidemiology === * Ubiquitous environmental organism, but rare..."

2020-08-03T02:09:35Z

Created page with "== Background == === Microbiology === * Fastidious Stain::Gram-positive Cellular shape::bacillus === Epidemiology === * Ubiquitous environmental organism, but rare..."

New page

== Background ==

=== Microbiology ===

* Fastidious [[Stain::Gram-positive]] [[Cellular shape::bacillus]]

=== Epidemiology ===

* Ubiquitous environmental organism, but rarely causes disease
** Can be found in saliva of one third of healthy people
* Disease is more common in white European males

=== Pathophysiology ===

* Lack of host immune response

== Clinical Manifestations ==

=== Classic Whipple's Disease ===

* Cardinal features include: [[arthralgias]], followed by [[weight loss]], [[diarrhea]], and [[abdominal pain]]
* Arthralgias are typically migratory in the larger peripheral joints, including knees, ankles, and wrists, but can have essentially any presentation
* The diarrhea is intermittent, with colicky abdominal pain
** Diarrhea can be watery or have steatorrhea
** Occasional GI bleeding

=== Other Symptoms ===

* Fever in 25 to 40%
* Lymphadenopathy, mostly of mesenteric and mediastinal nodes
* CNS disease
** [[Dementia]], [[supranuclear ophthalmoplegia]], [[nystagmus]], and [[myoclonus]]
** [[Oculomasticatory myorhythmia]] and [[oculo-facial-skeletal myorhythmia]] with a supranuclear vertical gaze palsy
** [[Cerebellar ataxia]]
** Symptoms can occur with disease or as a post-treatment relapse
* Cardiac disease
** Culture-negative [[endocarditis]], [[pericarditis]], and [[myocarditis]]
** Endocarditis may occur on its own without other features of disease
* Skin hyperpigmentation in 40%
* [[Pleural effusion]], [[chronic cough]], [[interstitial lung disease]], [[pulmonary hypertension]]
* [[Anemia]] in 80%, [[leukocytosis]] in 50%, [[thrombocytosis]] in 50%
* Elevated C-reactive protein in 70%

== Diagnosis ==

* Samples should be taken from involved sites, with a strong preference for small bowel biopsy if there are GI symptoms, but also synovial or cerebrospinal fluid or heart valve
** Up to 7 to 10 biopsies from small bowel, ideally
* Diagnosis is based on:
** Periodic acid-Schiff-positive bacilli in macrophages
** PCR
** Immunohistochemistry

== Management ==

* Generally treat with parenteral [[Is treated by::ceftriaxone]] 2 g IV daily or [[Is treated by::penicillin]] 2 MU IV q4h for 2 weeks followed by [[TMP-SMX]] DS PO bid for 1 year
** Treatment can precipitate a [[Jarisch-Herxheimer reaction]]
** May also see [[immune reconstitution inflammatory syndrome]] in early treatment
* Other options include [[meropenem]], [[doxycycline]], [[macrolides]], [[ketolides]], [[aminoglycosides]], [[rifampin]], [[teicoplanin]], and [[chloramphenicol]]
* Consider repeating small bowel biopsies annually for a few years

== Prognosis ==

* Clinical improvement takes 1 to 3 weeks of treatment
* Neurologic sequelae may be permanent
* Relapses after treatment, including of CNS disease, can happen in up to a third of patients

[[Category:Infectious diseases]]
[[Category:Gram-positive bacilli]]
[[Category:Gastrointestinal infections]]
[[Category:CNS infections]]