Whipple 病

Whipple 病是由革兰氏阳性细菌惠普尔养障体引起的慢性多系统性疾病，由 G.H. Whipple 于 1907 年首次记录。

受感染的患者通常为中年白人男性，可能出现体重减轻、关节痛、腹泻和发热等症状。

虽然惠普尔养障体广泛存在于环境中，但是其感染率很低。

主要根据十二指肠活检结果进行诊断。 组织学检查特点是，黏膜固有层出现泡沫样巨噬细胞，其细胞质中含有大量抗淀粉酶的过碘酸-希夫 (PAS) 阳性微粒。 根据脑脊液 (CSF) 或滑液的聚合酶链反应 (PCR) 检查结果可确诊。

建议采用静脉注射头孢曲松 14 天，然后改为口服甲氧苄啶/磺胺甲基异恶唑一年进行治疗。

Whipple 病是一种由惠普尔养障体引起的罕见多系统慢性传染病，惠普尔养障体是一种革兰阳性菌，属放线菌进化枝，基因组富含核苷酸鸟嘌呤和胞嘧啶（guanine and cytosine, G-C）。[1]Raoult D, Ogata H, Audic S, et al. Tropheryma whipplei twist: a human pathogenic Actinobacteria with a reduced genome. Genome Res. 2003 Aug;13(8):1800-9. http://genome.cshlp.org/content/13/8/1800.long http://www.ncbi.nlm.nih.gov/pubmed/12902375?tool=bestpractice.com [2]Bentley SD, Maiwald M, Murphy LD, et al. Sequencing and analysis of the genome of the Whipple's disease bacterium Tropheryma whipplei. Lancet. 2003 Feb 22;361(9358):637-44. http://www.ncbi.nlm.nih.gov/pubmed/12606174?tool=bestpractice.com 惠普尔养障体广泛存在于周围环境和健康带菌者。[3]Schoniger-Hekele M, Petermann D, Weber B, et al. Tropheryma whipplei in the environment: survey of sewage plant influxes and sewage plant workers. Appl Environ Microbiol. 2007 Mar;73(6):2033-5. http://aem.asm.org/cgi/content/full/73/6/2033 http://www.ncbi.nlm.nih.gov/pubmed/17277223?tool=bestpractice.com [4]Maiwald M, Schuhmacher F, Ditton HJ, et al. Environmental occurrence of the Whipple's disease bacterium (Tropheryma whippelii). Appl Environ Microbiol. 1998 Feb;64(2):760-2. http://aem.asm.org/cgi/content/full/64/2/760 http://www.ncbi.nlm.nih.gov/pubmed/9464419?tool=bestpractice.com [5]Fenollar F, Trani M, Davoust B, et al. Prevalence of asymptomatic Tropheryma whipplei carriage among humans and nonhuman primates. J Infect Dis. 2008 Mar 15;197(6):880-7. http://jid.oxfordjournals.org/content/197/6/880.full http://www.ncbi.nlm.nih.gov/pubmed/18419351?tool=bestpractice.com [6]Ehrbar HU, Bauerfeind P, Dutly F, et al. PCR-positive tests for Tropheryma whippelii in patients without Whipple's disease. Lancet. 1999 Jun 26;353(9171):2214. http://www.ncbi.nlm.nih.gov/pubmed/10392994?tool=bestpractice.com [7]Amsler L, Bauernfeind P, Nigg C, et al. Prevalence of Tropheryma whipplei DNA in patients with various gastrointestinal diseases and in healthy controls. Infection. 2003 Mar;31(2):81-5. http://www.ncbi.nlm.nih.gov/pubmed/12682812?tool=bestpractice.com [8]Maibach RC, Dutly F, Altwegg M. Detection of Tropheryma whipplei DNA in feces by PCR using a target capture method. J Clin Microbiol. 2002 Jul;40(7):2466-71. http://jcm.asm.org/cgi/content/full/40/7/2466 http://www.ncbi.nlm.nih.gov/pubmed/12089263?tool=bestpractice.com [9]Zinkernagel AS, Gmur R, Fenner L, et al. Marginal and subgingival plaque: a natural habitat of Tropheryma whipplei? Infection. 2003 Mar;31(2):86-91. http://www.ncbi.nlm.nih.gov/pubmed/12682813?tool=bestpractice.com [10]Rolain JM, Fenollar F, Raoult D. False positive PCR detection of Tropheryma whipplei in the saliva of healthy people. BMC Microbiol. 2007 May 29;7:48. http://www.biomedcentral.com/1471-2180/7/48 http://www.ncbi.nlm.nih.gov/pubmed/17535423?tool=bestpractice.com ​​ Whipple 病的遗传易感性似乎使感染得以发生。[11]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. http://www.ncbi.nlm.nih.gov/pubmed/18291339?tool=bestpractice.com [12]Fenollar F, Puechal X, Raoult D. Whipple's disease. N Engl J Med. 2007 Jan 4;356(1):55-66.​​ 患者通常为中年白人男性，表现为关节痛、体重减轻、腹泻和发热。[11]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. http://www.ncbi.nlm.nih.gov/pubmed/18291339?tool=bestpractice.com [12]Fenollar F, Puechal X, Raoult D. Whipple's disease. N Engl J Med. 2007 Jan 4;356(1):55-66.[13]Dobbins WO 3rd. Is there an immune deficit in Whipple's disease? Dig Dis Sci. 1981 Mar;26(3):247-52. http://www.ncbi.nlm.nih.gov/pubmed/6165533?tool=bestpractice.com [14]Dobbins WO. Whipple's disease. Springfield, IL: Thomas; 1987.​​​​​