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home - Small Bowel - Small Bowel Infections - Whipples Disease Written by Dr Sebastian Zeki

Whipples Disease

Clinical Features:Waisting and weight loss. Hyperpigmentation. Intestinal pain. Pleurisy. Pneumonitis. Lymphadenopathy. Encephalopathy. Steatorrhoea. Diarrhoea. Interstitial nephritis. Skin rashes. Eye inflammation. Athritis. Subcutaneous nodules. Endocarditis. I n t e s t i n a l e p i t h e l i u m Written by Dr Sebastian Zeki Whipple’s Disease DiagnosisD2 biopsies are PAS positive.PCR on CSF can give a positive result.PCR on blood is not good as it gives a high false +ve result. Behaves like MAC in AIDSTo grow, macrophages need deactivationTreat with IFNgamma in chronicityOrganism(35% in saliva and faeces) and IgG found (70%) in healthy volunteersMHC II downregulated in intestinal epithelial cells in infectees.This returns with treatment Low TH1Function Increased TH2 Function Low CD4/CD8 ratioMore matureIncreased activation T TreatmentThere is a high relapse rate with tetracycline.Initially give iv antibiotics known to penetrate blood brain barrier ( eg ceftriaxone/ penicillin G).After iv antibiotics give oral for 12 months (eg doxycycline/ TMP-SMX). Pathology....thought to be due to immune deficiency as evidenced by.....

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