Whipple Disease

Whipple disease is caused by an infection with the organism Tropheryma whipplei. The infection almost always affects the small intestine but can affect other organs, such as the heart, lungs, brain, joints, and eyes.

The four main symptoms of Whipple disease are

Other common symptoms are fever, loss of appetite, fatigue and weakness caused by anemia, cough, and pain when breathing caused by inflammation of the membrane layers covering the lungs (pleura). Fluid may collect in the space between the pleural layers (a condition called pleural effusion Pleural Effusion ). The lymph nodes may become enlarged. In some people, the skin becomes darker. People with Whipple disease may develop heart murmurs. Confusion, memory loss, or uncontrolled eye movements indicate that the infection has spread to the brain.

A doctor can make the diagnosis of Whipple disease by identifying bacteria in the small intestine.

To identify the bacteria, doctors remove tissue (biopsy) from the small intestine using an endoscope (a flexible viewing tube equipped with a light source and a camera through which a small clipper can be inserted) or remove tissue from an enlarged lymph node. The tissue is then examined under a microscope.

If left untreated, Whipple disease becomes progressively worse and is fatal.

Whipple disease can be cured with antibiotics. Usually people are given ceftriaxone or penicillin initially by vein for 2 to 4 weeks, followed by trimethoprim/sulfamethoxazole or a combination of doxycycline and hydroxychloroquine taken by mouth for at least 12 months. Symptoms subside rapidly. Despite an initial response to antibiotics, however, the disease can come back.