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)

The authors describe a case of Whipple's disease diagnosed early during gastroduodenofibroscopy from a bioptioc specimen of the prepyloric gastric mucosa, and treated in time. The disease was complicated by superinfection with Salmonella enteritidis. In the clinical picture digestive symptoms predominated, loose stools, malabsorption, loss of body weight, anaemia, skin pigmentation. After antibiotic and later chemotherapeutic treatment clinical symptoms receded and the histological finding in bioptic specimens from the stomach was normal.
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PMID:[Whipple's disease, early diagnosis, early therapy]. 1035 68

Whipple's disease has traditionally been considered to be a rare multisystem disorder dominated by malabsorption. The recent identification of the Whipple's disease bacillus has, using polymerase chain reaction based assays, fueled advances in the investigation, diagnosis, and management of this disease. This leader reviews the aetiology, clinical manifestations, investigation, and treatment of Whipple's disease in the light of this new information.
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PMID:Whipple's disease revisited. 1106 67

Whipple's disease (WD) is a rare systemic disease of infectious etiology which involves the small intestine but can virtually affect any organ. We present here five cases (four males and one female) ranging in age from 20 to 59 years. All patients had intestinal involvement associated or not with clinical manifestations linked to this organ. Vegetation in the tricuspid valve was observed in one patient, suggesting endocarditis caused by Tropheryma whippelii, with disappearance of the echocardiographic alterations after treatment. In one of the male patients the initial clinical manifestation was serologically negative spondylitis, with no diarrhea occurring at any time during follow-up. Ocular involvement associated with intestinal malabsorption and significant weight loss were observed in one case. In the other two cases, diarrhea was the major clinical manifestation. All patients were diagnosed by histological examination of the jejunal mucosa and, when indicated, of extraintestinal tissues by light and electron microscopy. After antibiotic treatment, full remission of symptoms occurred in all cases. A control examination of the intestinal mucosa performed after twelve months of treatment with sulfamethoxazole-trimethoprim revealed the disappearance of T. whippelii in four patients. The remaining patient was lost to follow-up.
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PMID:Whipple's disease. Report of five cases with different clinical features. 1124 83

Whipple's disease is a rare bacterial infection that may involve any organ system in the body. It occurs primarily in Caucasian males older than 40 years. The gastrointestinal tract is the most frequently involved organ, with manifestations such as abdominal pain, malabsorption syndrome with diarrhea, and weight loss. Other signs include low-grade fever, lymphadenopathy, skin hyperpigmentation, endocarditis, pleuritis, seronegative arthritis, uveitis, spondylodiscitis, and neurological manifestations, and these signs may occur in the absence of gastrointestinal manifestations. Due to the wide variability of manifestations, clinical diagnosis is very difficult and is often made only years or even decades after the initial symptoms have appeared. Trimethoprim-sulfamethoxazole for at least 1 year is usually considered adequate to eradicate the infection. The microbiological diagnosis of this insidious disease is rendered difficult by the virtual lack of culture and serodiagnostic methods. It is usually based on the demonstration of periodic acid-Schiff-positive particles in infected tissues and/or the presence of bacteria with an unusual trilaminar cell wall ultrastructure by electron microscopy. Recently, the Whipple bacteria have been characterized at the molecular level by amplification of their 16S rRNA gene(s). Phylogenetic analysis of these sequences revealed a new bacterial species related to the actinomycete branch which was named "Tropheryma whippelli." Based on its unique 16S ribosomal DNA (rDNA) sequence, species-specific primers were selected for the detection of the organism in clinical specimens by PCR. This technique is currently used as one of the standard methods for establishing the diagnosis of Whipple's disease. Specific and broad-spectrum PCR amplifications mainly but not exclusively from extraintestinal specimens have significantly improved diagnosis, being more sensitive than histopathologic analysis. However, "T. whippelii" DNA has also been found in persons without clinical and histological evidence of Whipple's disease. It is unclear whether these patients are true asymptomatic carriers or whether differences in virulence exist among strains of "T. whippelii" that might account for the variable clinical manifestations. So far, six different "T. whippelii" subtypes have been found by analysis of their 16S-23S rDNA spacer region. Further studies of the pathogen "T. whippelii" as well as the host immune response are needed to fully understand this fascinating disease. The recent cultivation of the organisms is a promising major step in this direction.
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PMID:Whipple's disease and "Tropheryma whippelii". 1143 14

Whipple's disease is an uncommon systemic disease caused by the recently cultured Tropheryma whippelii, classically presenting with gastrointestinal symptoms. We report a patient with weight loss and malabsorption in which Whipple's disease and concurrent Giardia lamblia infection were diagnosed. Moreover, multiple small bowel polyps were present. The relationship between concurrent Whipple's disease and Giardia lamblia infection is discussed.
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PMID:Concurrent Whipple's disease and Giardia lamblia infection in a patient presenting with weight loss. 1171 Dec 78

A 52 year old lady was admitted for progressive pedal oedema over a six year period and recent onset of hyperpigmentation. Laboratory investigations revealed that she was having a malabsorption syndrome with protein losing enteropathy. In view of associated arthralgia and higher mental function disturbances, a clinical diagnosis of Whipple's disease was postulated. Duodenal biopsy revealed infiltration of the lamina propria with PAS positive macrophages, suggestive of Whipple's disease. This case is being reported to highlight that Whipple's disease can manifest in the most unsuspecting manner and that early treatment can cure the patient.
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PMID:Whipple's disease. 1183 85

The case of a 61-year-old woman with Whipple's disease-associated sicca complex is reported. Tropheryma whipplei infection was diagnosed by histological and ultrastructural examination of the jejunal mucosa and sequence analysis of the bacterial 16S ribosomal DNA. The role of vitamin A malabsorption in sicca complex secondary to Whipple's disease is discussed.
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PMID:Sicca syndrome associated with Tropheryma whipplei intestinal infection. 1214 93

Whipple's disease is a rare, chronic, multisystemic disease characterized by the presence of fever, diarrhea, weight loss and malabsorption, preceded by arthritis. Although Whipple's disease almost always includes involvement of the small intestine and the presence of malabsorption, it commonly affects other organs, especially the heart, brain, eyes and joints. Whipple's disease greately mimics other diseases and is caused by a cultivation-resistant bacterium. The disease is fatal unless patients are treated with antibiotics. The diagnosis of Whipple's disease can be made by histologic analysis of small-intestinal biopsy specimens. Identification of Whipple bacterium, Tropheryma whippelii, has led to the development of the polymerase chain reaction This technique can be used to detect the bacterium in many organs and fluids, including synovial tissue and fluid. Affected patients tend to have dilated intestinal villi that are infiltrated with foamy macrophages.
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PMID:[Whipple's disease: progress in the diagnosis and review of the literature]. 1497 31

An improved folic acid absorption test is described in detail. Using the folic acid and other absorption tests, a study of intestinal function has been made in eight patients with lymphosarcoma, eight with chronic lymphocytic leukaemia, two with Hodgkin's disease, and one each with reticulum cell sarcoma, Whipple's disease, and macroglobulinaemia. It was found that laboratory evidence of intestinal malabsorption was extremely common in patients with this group of diseases. The folic acid absorption test was the most sensitive single index of malabsorption of the tests used in this study. Correlation between the different absorption tests was poor, and there does not appear to be a characteristic biochemical profile of intestinal function in these patients.
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PMID:Folic acid and other absorption tests in lymphosarcoma, chronic lymphocytic leukaemia, and some related conditions. 1373 1

The central nervous system (CNS) may be affected in up to 50% of patients with Whipple's disease and this can occur even with little or no gastrointestinal involvement. We describe a 63-year-old patient in whom CNS involvement with Whipple's disease had the clinical and imaging features of a brain infarction. Treatment with aspirin and ceftriaxone followed by trimethoprim-sulfamethoxazole resulted in a good neurological recovery and complete remission of the malabsorption syndrome. Cerebral Whipple's disease resembling a stroke syndrome has so far been reported in only two other patients and in both cases it represented the first presentation of the disease. Arterial or arteriolar fibrosis, thrombosis and thickening associated with the inflammation of adjacent brain parenchyma and leptomeninges, and cerebral vasculitis caused by the hematogenous spread of Tropheryma whippelii to the brain may all be important triggers of brain infarction in patients with Whipple's disease. Our case report highlights the important point that cerebral Whipple's disease with the features of a stroke syndrome, if recognized early and treated aggressively with antibiotics, could have a favorable course with no long-term disability sequelae.
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PMID:A patient with cerebral Whipple's disease and a stroke-like syndrome. 1603 16


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