Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- diarreia
- perda de peso
- artralgia
- oftalmoplegia supranuclear
Other diagnostic factors
- dor abdominal
- linfadenopatia
- febre
- esteatorreia
- anemia
- escurecimento da pele
- confusão, comprometimento da memória, alteração do nível de consciência ou demência
- apatia
- ansiedade, depressão, hipomania, psicose, alteração de personalidade
- sinais mioclônicos
- convulsões
- nistagmo
- reflexos vivos, reflexos cutâneo-plantares em extensão, fraqueza predominante em músculos extensores dos braços e flexores das pernas, hipertonia
- amenorreia, polidipsia, hiperfagia, diminuição da libido
- ataxia
- cefaleias
- miorritmias oculomastigatória e oculofacioesquelética
- hemiparesia
- comprometimento de nervos cranianos
- distúrbio do movimento extrapiramidal
- neuropatias periféricas
Risk factors
- idade >50 anos
- sexo masculino
- fatores genéticos
Diagnostic investigations
1st investigations to order
- Hemograma completo
- albumina sérica
- proteína C-reativa sérica
- velocidade de hemossedimentação (VHS) sérica
- endoscopia digestiva alta
- coloração de biópsias duodenais com ácido periódico de Schiff (PAS)
- reação em cadeia da polimerase
- Imuno-histoquímica específica para Tropheryma whipplei
Emerging tests
- microscopia eletrônica
- cultura
- sorologia
Treatment algorithm
pacientes sem comprometimento do sistema nervoso central (SNC)
pacientes com comprometimento do sistema nervoso central (SNC)
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.
References
Key articles
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. Abstract
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. Abstract
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.Full text Abstract
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. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Artrite reumatoide soronegativa
- Sarcoidose
- Doença celíaca
More DifferentialsPatient information
Diarreia em crianças
Artrite reumatoide
More Patient information
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