What happens in the body
The bacterium penetrates the mucous membrane of the small intestine, where it is captured by special cells - macrophages. For most people, this is where it all ends, but with certain characteristics of the immune system, macrophages cannot digest the microorganism and gradually accumulate it inside. The swollen cells fill the villi and lymphatic vessels of the intestine. The absorption of fats, proteins, and vitamins deteriorates sharply, and lymph cannot drain. The pathogen can spread beyond the intestine: to the joints, heart, lymph nodes and brain. This is why the disease manifests itself in so many different ways.
- Pathogen: Tropheryma whipplei
- The small intestine is primarily affected
- The absorption and outflow of lymph is impaired
- Possible damage to joints, heart and brain
- Middle-aged men are more likely to get sick
Symptoms and stages
The disease usually develops in two phases. The first lasts for years: migrating pain in the joints is disturbing, sometimes with swelling, but without persistent deformities and without changes in the photographs. The second phase is intestinal: profuse fatty stools, bloating, cramping pain, progressive weight loss, and severe weakness appear. Due to protein deficiency, swelling occurs; due to a lack of vitamins, anemia, dry skin, and bleeding gums occur. Fever and swollen lymph nodes are common. Signs of damage to the nervous system - memory impairment, behavioral changes, oculomotor disorders - require special attention.
- Migrating joint pain years before intestinal complaints
- Chronic diarrhea, fatty, profuse stools
- Weight loss and severe weakness
- Bloating and abdominal pain
- Fever, swollen lymph nodes
- Swelling due to protein loss
- Memory and eye movement disorders
Diagnostics
The combination of complaints itself helps to suspect the disease: prolonged joint pain that does not fit into a rheumatic diagnosis, plus diarrhea and weight loss. The main method is gastroscopy with the obligatory taking of several biopsies from the duodenum and jejunum. During histological examination, characteristic macrophages are found in the mucosa, filled with material stained with a special method. The diagnosis is confirmed by detection of pathogen DNA using PCR. Blood tests show anemia, decreased albumin, and increased inflammatory parameters. For neurological symptoms, the cerebrospinal fluid is examined.
- Gastroscopy with multiple biopsies of the small intestine
- Histological examination with special staining
- PCR for Tropheryma whipplei
- Clinical blood test and ESR
- Albumin and total protein
- Abdominal ultrasound to evaluate lymph nodes
- Cerebrospinal fluid examination for neurological symptoms
Treatment
Whipple's disease is treated with antibiotics, and the doctor selects the regimen taking into account the damage to the nervous system. The peculiarity is that the course is very long: they usually start with intravenous administration of drugs that penetrate the blood-brain barrier, and then switch to long-term oral administration, which lasts at least a year. It is impossible to stop treatment when you feel better - it is premature cancellation that leads to the return of the disease. At the same time, they replenish the deficiency of protein, iron, vitamins and microelements, and correct nutrition. At the beginning of treatment, sometimes there is a temporary deterioration with fever, which the doctor warns about in advance.
- Long-term antibacterial therapy according to the doctor’s regimen
- The initial stage is often intravenous
- Total duration of at least one year
- You cannot interrupt the course when improving
- Replenishment of vitamins, iron and protein
- Correction of nutrition and calorie intake
- Control biopsies and PCR after treatment
Observation and forecast
With proper treatment, health improves quickly: diarrhea stops, weight begins to be restored within a few weeks. However, complete cleansing of the mucous membrane from the pathogen takes months, so control gastroscopy with biopsy and PCR is prescribed. Relapses are possible, especially if the nervous system is damaged, so observation continues for years. Without treatment, the disease steadily progresses and ends in severe exhaustion, so it is important not to delay examination for prolonged diarrhea with weight loss. The prognosis with timely initiation of therapy is usually favorable.
- Rapid improvement in well-being in the first weeks
- Control biopsy and PCR according to schedule
- Observation over several years
- Particular attention in neurological forms
- Without treatment, the prognosis is extremely poor