Whipple disease

Last reviewed: 27 Apr 2022
Last updated: 29 Apr 2020

Summary

Definition

History and exam

Key diagnostic factors

  • diarrhea
  • weight loss
  • arthralgia
  • supranuclear ophthalmoplegia
More key diagnostic factors

Other diagnostic factors

  • 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
Other diagnostic factors

Risk factors

  • age >50 years
  • male sex
  • genetic factors
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC
  • serum albumin
  • serum CRP
  • serum ESR
  • upper GI endoscopy
  • Periodic acid-Schiff (PAS) staining of duodenal biopsies
  • PCR
  • Tropheryma whipplei-specific immunohistochemistry
More 1st investigations to order

Emerging tests

  • electron microscopy
  • culture
  • serology

Treatment algorithm

ACUTE

patients without CNS involvement

patients with CNS involvement

Contributors

Authors

Thomas Schneider, MD, PhD

Professor

Medical Department I

Charité - University Medicine Berlin

CBF

Berlin

Germany

Disclosures

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

Disclosures

VM is an author of a number of references cited in this topic.

Peer reviewers

Stephen G. Baum, MD

Professor of Medicine

Department of Microbiology and Immunology

Albert Einstein College of Medicine

Bronx

NY

Disclosures

SGB declares that he has no competing interests.

Chris Huston, MD

Assistant Professor of Medicine

Division of Infectious Diseases

University of Vermont

Burlington

VT

Disclosures

CH declares that he has no competing interests.

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