Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0024523 (malabsorption)
 7,319 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A typical case of Whipple's disease was manifested by malabsorption and nondeforming peripheral arthritis for five years. A definite diagnosis was made by duodenal mucosal biopsy which revealed the characteristic histologic features by light microscopy, intracellular and extracellular Whipple's bacilli by electron microscopy, and a typical immune cross-reactivity pattern by immunofluorescence technique. Whipple's bacilli apparently elicit no effective humoral and cellular immune response; macrophages thus play the key role in its pathogenesis. Antibiotic treatment resulted in a dramatic relief of symptoms and rapid restoration of body weight. We stress that in patients with nondeforming peripheral arthritis associated with malabsorption syndrome, Whipple's disease, despite its rarity, should be included in the differential diagnosis.
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PMID:Whipple's disease: pathogenetic considerations. 618 69

An unusual case of Whipple's disease is reported. The diagnosis was difficult as the characteristic digestive sign and symptoms (malabsorption, diarrhea, mucosal infiltration by PAS-positive macrophages) were absent. After a ten-year history of seronegative arthritis, myocardiopathy, with aortic insufficiency, basilar pulmonary infiltrates, enlarged lymph nodes, the patient, a 56 years old man, was referred to us for a severe vegetative and neurological dysfunction: stupor, dysarthria, akinesia, hypertonia, hypothermia and abnormal thirst. A CT-scan showed a low-density area of the right hypothalamus, and PAS-positive macrophages were found in a lymph node, in the CSF and in a cerebral biopsy. The patient then received a classical antibiotic treatment, yet the neurologic dysfunction remained severe. Finally, a trial with rifampicin brought a striking improvement of the patient's condition, which has now lasted for three years.
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PMID:[Hypothalamic form of Whipple's disease. Favorable effect of rifampicin]. 619 50

A previously healthy 67-yr-old man presented with progressive dementia over an 11-mo period. Evaluation revealed evidence of malabsorption. Jejunal biopsy established the diagnosis of Whipple's disease. No other etiology for the patient's dementia was uncovered. Treatment with trimethoprim-sulfamethoxazole resulted in rapid elimination of Whipple's bacilli from the jejunum and complete reversal of the patient's dementia over a 6-mo period. Significant levels of trimethoprim and sulfamethoxazole were easily quantitated in the cerebrospinal fluid during therapy. There is increasing recognition of progressive neurologic disease in patients with Whipple's disease who were treated with tetracycline. The reversal of presumed central nervous system disease in this case suggests that drugs that penetrate the blood-brain barrier might be preferable for the initial treatment of Whipple's disease.
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PMID:Reversal of dementia associated with Whipple's disease by trimethoprim-sulfamethoxazole, drugs that penetrate the blood-brain barrier. 619 55

A case of Whipple's disease initially presenting as an inflammatory, granulomatous and pseudotumorous infiltration of the mesenterium is discussed. The initial diagnosis of mesenteric panniculitis was invalidated by the typical histological findings of Whipple's disease in a duodenal biopsy performed 18 months later for malabsorption syndrome. This case illustrates the difficulties besetting differential diagnosis of inflammatory and granulomatous lesions of the mesenterium.
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PMID:[A case of Whipple disease with a pseudotumorous presentation: differential diagnosis with mesenteric panniculitis]. 620 Sep 27

Whipple's disease is an inflammatory illness primarily afflicting middle-aged men. Although originally seen as a disease of intestinal malabsorption, it may affect any body system causing numerous signs and symptoms. These are due to infiltration of macrophages containing sickleform particles which stain PAS-positive. Definitive diagnosis is made by biopsy, and treatment is with broad-spectrum antibiotics. There seems to be an infectious component to the disease although defective immunologic responses may be implicated. Exact etiology is unknown. Although a rare illness, there has recently been increased recognition of this disease. Neurological involvement occurs with dissemination of lesions to the nervous system. Symptoms are quite varied but most often include dementia. As is apparent from the patient history, early diagnosis and treatment is imperative. Even without symptoms, there should probably be treatment for central nervous system involvement since neurological manifestations are often fatal. The case study presented illustrates a multisystem illness. The neurological presentation includes peripheral neuropathy, cranial nerve involvement, brainstem dysfunction, endocrine disturbance, thalamic or pituitary symptoms, and changes in cerebral function. Nursing measures reinforce the importance of the role of primary nursing for patient care and the necessity of comprehensive nursing care plans. Management problems were alleviated by providing consistency and continuous orientation, by involving the patient and his family in the plan of care, and by establishing a safe and consistent environment. Nursing process can improve and enhance patient responses, family coping ability, and the quality of care given. A "difficult" patient can help to expand nursing knowledge as well as promote personal growth and satisfaction.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Neurological involvement with Whipple's disease. 620 14

We report a case of severe chronic bilateral uveitis in a 60-year-old white man without neurological manifestations. Spondylarthritis and isolated malabsorption suggested the diagnosis of Whipple's disease. A normal duodenal biopsy delated the diagnosis, who was secondarily demonstrated an adenopathy biopsy and macrophage study on vitrectomy sample (macrophage distended by periodic acid-Schiff positive material). With 1 year follow-up the uveitis was rapidly and completely cured by an antibiotic association (rifampicin and trimethoprim-sulfamethoxazol). The characteristics of ocular involvement in Whipple's disease and treatment of the disease are discussed.
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PMID:[Uveitis: late complication of undiagnosed Whipple disease]. 748 Nov 57

Two cases of Whipple's disease with secondary amyloidosis are described. One patient had a nephrotic syndrome, the other malabsorption. The chronic inflammatory stimulus of Whipple's disease is discussed as a trigger for the development of secondary amyloidosis. The clinical symptoms of seronegative arthritis, weight loss, chronic diarrhea, intermittent fever and lymphadenopathy may be the clue to the diagnosis of Whipple's disease. Peroral intestinal biopsy is the diagnostic procedure of choice. Adequate antibiotic treatment with a regimen of penicillin and trimethoprim-sulfamethoxazole is indicated and prevents the development of secondary amyloidosis.
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PMID:[Whipple's disease--a rare cause of secondary amyloidosis]. 751 14

Whipple's disease is a multisystemic disorder in which almost all organ systems can be invaded by rod-shaped bacteria. Without extended antimicrobial therapy, its course is lethal. Empirically, treatment consists of tetracyclines given for one to two years. Trimethoprim-sulfamethoxazole, a compound that crosses the blood-brain barrier, has been suggested as an alternative when patients were observed with progressive cerebral involvement. There has never been a formal evaluation of the selection of antibiotics for the treatment of Whipple's disease. In the present nonrandomized, partially retrospective study, we compared the result of two treatment regimens in 30 patients, all examined personally. Twenty-two patients were treated with tetracycline and eight patients with trimethoprim-sulfamethoxazole. In five patients, therapy with tetracycline was changed to another antimicrobial agent because of treatment failure or drug intolerance. The main treatment measure was disappearance of the clinical symptoms such as weight loss, arthritis, malabsorption, fever, edema, central nervous system manifestations, lymphadenopathy, and congestive heart failure. Drug intolerance requiring a change of medication was also considered a treatment failure. We found that trimethoprim-sulfamethoxazole induced complete clinical remission in 12 of 13 treatment cycles, tetracycline in 13 of 22 treatment cycles (P < 0.05; mean difference 33%; 95% confidence interval 8% to 58%). Trimethoprim-sulfamethoxazole was also more efficacious than tetracycline in the treatment of cerebral Whipple's disease. However, trimethoprim-sulfamethoxazole did not prevent cerebral manifestations in all cases. The only deaths due to Whipple's disease occurred in patients with cerebral involvement. It is concluded that treatment with trimethoprim-sulfamethoxazole was significantly superior to that with tetracycline in inducing clinical remission of Whipple's disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:An evaluation of antimicrobial treatment for Whipple's Disease. Tetracycline versus trimethoprim-sulfamethoxazole. 751 38

We present 66 year old man with symptoms of malabsorption syndrome. The correct diagnosis of Whipple's disease was made difficult by the radiological picture of the jejunum tumor with subocclusion. It was the cause of the diagnosis of carcinoid tumor of the small intestine: the laparotomy was performed. The histological picture was typical for Whipple's disease. The skin changes seen in our patient were similar like in carcinoid syndrome, pellagra and Whipple's disease.
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PMID:[A case of Whipple's disease]. 752 Oct 49

Whipple's disease is a chronic systemic infectious disease caused by Tropheryma whippelii that typically involves the small intestine and causes malabsorption. Extraintestinal manifestations such as arthritis and fever are common and often exist prior to the onset of gastrointestinal symptoms. Involvement of the central nervous system can occur and lead to permanent sequelae. Weight loss, hyperpigmentation, and lymphadenopathy are frequent findings. The definitive diagnosis is made by biopsy of the small intestine mucosa which reveals infiltration of the lamina propria of the small intestine with periodic acid-Schiff positive macrophages. Treatment with trimethoprim combined with sulfamethoxazole for 1 year usually results in clinical remission and an excellent prognosis. Recent advances using molecular techniques to identify the uncultured bacillus of Whipple's disease should lead to a better understanding of the pathophysiology and allow for the development of a sensitive noninvasive diagnostic test.
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PMID:Whipple's disease. 758 31


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