Abstract
Since the first successful antibiotic treatment of Whipple’s disease in 1952, many breakthroughs have occurred in the diagnosis and treatment of this disease that was once thought fatal. This article provides a historic overview and highlights recent encouraging discoveries regarding this underdiagnosed disease, including the use of polymerase chain reaction techniques and the recent cultivation of the Tropheryma whippelii bacterium.
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References and Recommended Reading
Whipple GH: A hitherto undescribed disease characterized anatomically by deposits of fat and fatty acids in the intestinal and mesenteric lymphatic tissues. Bull Johns Hopkins Hosp 1907, 18:382–391.
Black-Schaffer B: The tinctorial demonstration of a glycoprotein in Whipple's disease. Proc Soc Exp Biol Med 1949, 72:225–227.
Paulley JW: A case of Whipple's disease. Gastroenterology 1952, 22:128–133.
Yardley JH, Hendrix TR: Combined electron and light microscopy in Whipple's disease: demonstration of ‘bacillary bodies’ in the intestine. Bull Johns Hopkins Hosp 1961, 109:80–90.
Relman DA, Schmidt TM, MacDermott RP, Falkow S: Identification of the uncultured bacillus of Whipple's disease. N Engl J Med 1992, 327:293–301.
Raoult D, Birg ML, La Scola B, et al.: Cultivation of the bacillus of Whipple's disease. N Engl J Med 2000, 342:620–625. This landmark paper on cultivation of the T. whippelii bacterium could lead to a major increase in understanding.
Durand DV, Lecomte C, Cathebras P, et al.: Whipple's disease: clinical review of 52 cases. Medicine 1997, 6:170–184. Important review of epidemiologic data.
Enzinger FM, Helwig EB: Whipple's disease: a review of the literature and report of 15 patients. Virchows Arch 1963, 336:238–269.
Dobbins WO III: Whipple's Disease. Springfield, IL: Charles C. Thomas; 1987.
Feldman M: Whipple's disease. Am J Med Sci 1986, 291:56–67.
Bai JC, Mota AH, Maurino E, et al.: Class 1 and class 2 HLA antigens in a homogenous Argentinian population with Whipple's disease: lack of association with HLA-B-27. Am J Gastroenterol 1991, 86:992–994.
Maiwald M, Schumacher F, Ditton HJ, et al.: Environmental occurrence of Whipple's disease bacterium (Tropheryma whippelli). Appl Environ Microbiol 1998, 64:760–762. These authors argue for an oral source of infection.
Keren DF, Weisburger WR, Yardley JH, et al.: Whipple's disease: demonstration by immunofluorescence of similar bacterial antigens in macrophages from three cases. Johns Hopkins Med J 1976, 139:51–59.
Misbah SA, Ozols B, Franks A, et al.: Whipple's disease without malabsorption: new atypical features. Q J Med 1997, 90:765–772. Important therapeutic implications arose from this reported study and that of Marth et al. [15].
Marth T, Nuerath M, Cuccherini B, et al.: Defects of monocyte interleukin-12 production and humoral immunity in Whipple's disease. Gastroenterology 1997, 113:442. See previous annotation.
Weiner SR, Utsinger P: Whipple's disease. Semin Arthritis Rheum 1986, 15:155–167.
McGettigan P, Mooney EE, Sinnott M, et al.: Sudden death in Whipple's disease. Postgrad Med J 1997, 73:509–511.
Flemming JL, Wiesner RH, Shorter RG: Whipple's disease: clinical, biochemical and histopathologic features and assessment of treatment in 29 patients. Mayo Clin Proc 1988, 63:539–551.
Maizel H, Ruffin JM, Dobbins WO III: Whipple's disease: a review of 19 patients from one hospital and a review of the literature since 1950. Medicine 1970, 49:175–205.
Riehman JH, Rosch W: Synopsis of endoscopic and related morphological findings in Whipple's disease. Endoscopy 1978, 10:98.
Phillips RL, Carlson HC: The roentgenographic and clinical findings in Whipple's disease. Am J Roentgenol 1975, 124:268.
Comer GM, Brandt LJ, Abissi CJ: Whipple's disease: a review. Am J Gastroenterol 1983, 78:107–114.
Trier JS: Whipple's disease. In Fleisenger and Fordran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, and Management, edn 6. Edited by Feldman M, Scharschmidt BF, Sleisenger M, Zorab R. Philadelphia: WB Saunders; 1997.
Roth RI, Own RL, Keren DF: AIDS with Mycobacterium avium: intracellular lesions resembling those of Whipple's disease. N Engl J Med 1983, 309:1323.
Dobbins WO III, Klipstein FA: Chronic infections of the small intestine. In Textbook of Gastroenterology. Edited by Yamada T. Philadelphia: Lippincott; 1991:1472–1484.
Johnson L, Diamond I: Cerebral Whipple's disease: diagnosis by brain biopsy. Am J Clin Pathol 1979, 74:486.
Muller C, Petermann D, Stain C, et al.: Whipple's disease: comparison of histology with diagnosis based on polymerase chain reaction in four consecutive cases. Gut 1997, 40:425–427.
Rickman LS, Freeman WR, Green WR, et al.: Uveitis caused by Tropheryma whippelii. N Engl J Med 1995, 332:363–366.
Gras E, Xavier MG, Arnold G, et al.: PCR analysis in the pathological diagnosis of Whipple's disease: emphasis on extraintestinal involvement or atypical morphological features. J Pathol 1999, 188:318–321.
Rubino A, Canoso JJ, Goldenberg DL, Cohen AS: Synovial fluid and synovial membrane pathology in Whipple's disease [abstract]. Arthritis Rheum 1976, 19:820.
Celard M, Gevigney N, Mosnier S, et al.: Polymerase chain reaction analysis for diagnosis of Tropheryema whippelii infective endocarditis in two patients with no previous evidence of Whipple's disease. Clin Infect Dis 1995, 20:501–516.
Ehrbar HA, Bauerfeind P, Dutly F, et al.: PCR-positive tests for Tropheryema whippelii in patients without Whipple's disease. Lancet 1999, 353:2214. Report of high specificity for duodenal biopsy specimens through PCR analysis.
Ramzan NN, Loftus E, Burgart LJ, et al.: Diagnosis and monitoring of Whipple's disease by polymerase chain reaction. Ann Intern Med 1997, 126:520–527.
Schneider T, Stallmack A, vonHerbay G, et al.: Successful treatment of refractory Whipple's disease with adjunctive interferon gamma therapy [abstract]. Gastroenterology 1997, 112:1085. Important report of symptoms found in patients with cerebral involvement treated with trimethoprim-sulfamethoxazole.
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Flemmer, M.C., Flenner, R.W. Toward a new understanding of Whipple’s disease. Curr Gastroenterol Rep 2, 299–304 (2000). https://doi.org/10.1007/s11894-000-0022-z
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DOI: https://doi.org/10.1007/s11894-000-0022-z