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Vergleichende ultrastrukturelle und klinische Studie zum Ablauf des M. Whipple

Comparative ultrastructural and clinical studies of the course of Whipple's disease

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Summary

The clinical and histomorphological signs and symptoms of Whipple's disease are fundamentally altered by antibiotic therapy. The florid, untreated stage is demonstrated by watery diarrhoea and steatorrhoea, signs of deficiencies due to malabsorption and cachexia. Numerous SPC cells, dilated lymph vessels and extracellular Gram-positive bacteria can be demonstrated in light and electron microscopy. With antibiotic therapy a rapid return to near normal clinical conditions ensues. At the some time a massive destruction of bacteria can be demonstrated in the electron microscope. Simultaneously the stratum proprium becomes sclerosed. The favourable therapeutic effect and the catabolic effects on the bacteria seen electron microscopically allow one to postulate an infectious genesis of Whipple's disease.

Zusammenfassung

Unter antibiotischer Therapie kommt es zu grundlegenden Veränderungen des klinischen und histomorphologischen Erscheinungsbildes des M. Whipple. Das floride, unbehandelte Stadium ist gekennzeichnet durch wäßrige Diarrhoen bzw. Steatorrhoen, Mangelsymptomatik im Sinne eines Malabsorptions-Syndroms und Kachexie. Histomorphologisch bzw. elektronenoptisch lassen sich zahlreiche SPC-Zellen, erweiterte Lymphgefäße und extracellulär gelegene Gram-positive Bakterien nachweisen. Unter antibiotischer Therapie tritt sehr bald eine weitgehende Normalisierung der klinischen Symptomatik ein. Elektronenoptisch kann etwa zur gleichen Zeit ein massiver Bakterienabbau objektiviert werden. Gleichzeitig kommt es zu einer Sklerosierung des Stratum proprium. Die günstigen therapeutischen Effekte und die elektronenmikroskopisch nachweisbaren Abbauvorgänge an den Bakterien lassen eine infektiöse Genese des M. Whipple als wahrscheinlich erscheinen.

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  1. Pathologisches Institut der Universität Hamburg, I. Medizinische Klinik der Universität Hamburg, Germany

    H. F. Otto & F. Begemann

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Otto, H.F., Begemann, F. Vergleichende ultrastrukturelle und klinische Studie zum Ablauf des M. Whipple. Virchows Arch. Abt. A Path. Anat. 350, 368–388 (1970). https://doi.org/10.1007/BF00578544

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