Resumen
Definición
病史和体格检查
关键诊断因素
- diarrhea
- weight loss
- arthralgia
- supranuclear ophthalmoplegia
其他诊断因素
- abdominal pain
- lymphadenopathy
- fever
- steatorrhea
- anemia
- skin darkening
- confusion, memory impairment, altered level of consciousness, or dementia
- apathy
- anxiety, depression, hypomania, psychosis, change in personality
- myoclonic signs
- seizures
- nystagmus
- brisk reflexes, extensor plantar responses, weakness predominating in arm extensors and leg flexors, hypertonia
- amenorrhea, polydipsia, hyperphagia, decreased libido
- ataxia
- headaches
- oculomasticatory and oculofacioskeletal myorhythmias
- hemiparesis
- cranial nerve involvement
- extrapyramidal movement disorder
- peripheral neuropathies
危险因素
- age >50 years
- male sex
- genetic factors
诊断性检查
首要检查
- CBC
- serum albumin
- serum CRP
- serum ESR
- upper GI endoscopy
- Periodic acid-Schiff (PAS) staining of duodenal biopsies
- PCR
- Tropheryma whipplei-specific immunohistochemistry
新兴检查
- electron microscopy
- culture
- serology
治疗流程
patients without CNS involvement
patients with CNS involvement
撰稿人
作者
Thomas Schneider, MD, PhD
Professor
Medical Department I
Charité - University Medicine Berlin
CBF
Berlin
Germany
利益声明
TS is an author of a number of references cited in this topic.
Verena Moos, PhD
Scientist
Medical Department I
Charité - University Medicine Berlin
CBF
Berlin
Germany
利益声明
VM is an author of a number of references cited in this topic.
同行评议者
Stephen G. Baum, MD
Professor of Medicine
Department of Microbiology and Immunology
Albert Einstein College of Medicine
Bronx
NY
利益声明
SGB declares that he has no competing interests.
Chris Huston, MD
Assistant Professor of Medicine
Division of Infectious Diseases
University of Vermont
Burlington
VT
利益声明
CH declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Schneider T, Moos V, Loddenkemper C, et al. Whipple's disease: new aspects of pathogenesis and treatment. Lancet Infect Dis. 2008 Mar;8(3):179-90. 摘要
Fenollar F, Puechal X, Raoult D. Whipple's disease. N Engl J Med. 2007 Jan 4;356(1):55-66.
Dobbins WO. Whipple's disease. Springfield, IL: Thomas; 1987.
Louis ED, Lynch T, Kaufmann P, et al. Diagnostic guidelines in central nervous system Whipple's disease. Ann Neurol. 1996 Oct;40(4):561-8. 摘要
Feurle GE, Junga NS, Marth T. Efficacy of ceftriaxone or meropenem as initial therapies in Whipple's disease. Gastroenterology. 2010 Feb;138(2):478-86; quiz 11-2.全文 摘要
Feurle GE, Moos V, Bläker H, et al. Intravenous ceftriaxone, followed by 12 or three months of oral treatment with trimethoprim-sulfamethoxazole in Whipple's disease. J Infect. 2013 Mar;66(3):263-70. 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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