Whipple’s disease: how to recognize the symptoms and treat it

Whipple’s disease is a bacterial infection caused by ‘Tropheryma whipplei’ that has a very low prevalence. It affects the digestive tract causing malabsorption of nutrients in the small intestine. It also involves the joints, lymph nodes, heart, central nervous system, lungs, and other tissues. The largest number of cases have been recorded in men between 40 and 50 years old. It is very rare.

Causes of Whipple’s disease

Diner

Very little is known about ‘Tropheryma whipplei’ except that it is a commensal germ found in saliva, gastric juice, digestive mucosa and feces). It is believed to be acquired orally and can remain in the tissues without causing symptoms for years. The cause why it is activated and becomes pathogenic is unknown. The infection is triggered via blood or lymph.

‘Tropheryma whipplei’ first affects the mucosa of the small intestine, producing small lesions in the intestinal wall and damaging the villi of the small intestine.

Symptoms of Whipple’s disease

Joint pain and others

The symptoms of Whipple’s disease begin slowly with pain in the joints (ankles, knees, elbows, fingers…). Other symptoms are:

– Swollen joints.

– Abdominal pain.

– Diarrhea.

-Fever.

– Hyperpigmentation of skin exposed to the sun.

– Abdominal pain and cramps in the abdomen that may worsen after meals.

– Involuntary weight loss.

– Fatigue.

– Weakness.

– Anemia.

– Fever.

– Cough.

– Enlargement of lymph nodes.

– Enlargement of the spleen.

– Chest pain.

– Disorientation.

– Memory leak.

– Visual damage.

– Difficulty walking.

If Whipple’s disease is not detected and treated, although rare, it is progressive and potentially fatal, especially if the infection spreads to the central nervous system. This occurs because the diagnosis can be late.

Diagnosis of Whipple’s disease

Physical exam and biopsy

The physical examination, medical history, blood work, and upper endoscopy to perform a biopsy of the lining of the small intestine are the tests to reach a diagnosis of Whipple’s disease.

Whipple’s disease treatment and medication

Antibiotics

The reference treatment is intravenous antibiotics that pass the blood-brain barrier, such as cotrimoxazole or ceftriaxone, to avoid neurological relapses. Biopsies of the intestine should be performed within five years of diagnosis if intestinal involvement is present. In the rest of the cases it must be done for at least ten years. Relapses are common and can occur even years after the first diagnosis and treatment.

Whipple disease prevention

There are no prescribed measures

There are no prescribed prevention measures against Whipple’s disease due to how little is known about the bacteria. Due to the malabsorption of nutrients that the disease entails, the doctor may recommend an additional boost of vitamin D, folic acid, calcium, iron and magnesium thanks to the intake of vitamin and mineral supplements.