Whipple disease
小结
定义
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
Algoritmo de tratamento
patients without CNS involvement
patients with CNS involvement
Colaboradores
Autores
Thomas Schneider, MD, PhD
Professor
Medical Department I
Charité - University Medicine Berlin
CBF
Berlin
Germany
Declarações
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
Declarações
VM is an author of a number of references cited in this topic.
Revisores
Stephen G. Baum, MD
Professor of Medicine
Department of Microbiology and Immunology
Albert Einstein College of Medicine
Bronx
NY
Declarações
SGB declares that he has no competing interests.
Chris Huston, MD
Assistant Professor of Medicine
Division of Infectious Diseases
University of Vermont
Burlington
VT
Declarações
CH declares that he has no competing interests.
Créditos aos pareceristas
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Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
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. Resumo
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. Resumo
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.Texto completo Resumo
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. Resumo
Artigos de referência
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