Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- diarrhea
- weight loss
- arthralgia
- supranuclear ophthalmoplegia
Outros fatores diagnósticos
- 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
Fatores de risco
- age >50 years
- male sex
- genetic factors
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- CBC
- serum albumin
- serum CRP
- serum ESR
- upper GI endoscopy
- Periodic acid-Schiff (PAS) staining of duodenal biopsies
- PCR
- Tropheryma whipplei-specific immunohistochemistry
Novos exames
- 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.
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.
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
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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