Whipple Disease
Actinobacteria
Duodenum
Pancreaticoduodenectomy
Ampulla of Vater
Whipple's disease mimicking progressive supranuclear palsy: the diagnostic value of eye movement recording. (1/147)
Treatable causes of parkinsonian syndromes are rare; Whipple's disease is one of them. A patient is described who presented with a parkinsonian syndrome and abnormal vertical gaze. Measurement of eye movements showed marked slowing of upward saccades, moderate slowing of downward saccades, a full range of voluntary vertical eye movements, curved trajectories of oblique saccades, and absence of square wave jerks. These features, atypical of progressive supranuclear palsy, suggested the diagnosis of Whipple's disease, which was subsequently confirmed by polymerase chain reaction analysis of intestinal biopsy material. Precise measurement of the dynamic properties of saccadic eye movements in parkinsonian patients may provide a means of identifying treatable disorders. (+info)Whipple's arthritis: direct detection of Tropheryma whippelii in synovial fluid and tissue. (2/147)
We describe 2 patients presenting with polyarthritis in whom the synovial fluid (1 patient) or synovial tissue (1 patient) was positive for Tropheryma whippelii, the Whipple's disease-associated bacillus, when examined by polymerase chain reaction (PCR) and DNA sequencing. Histopathologic findings were consistent with articular Whipple's disease in the synovial fluid of 1 patient and the synovial tissue of the other. In both patients, bowel mucosal specimens were negative for Whipple's disease features by histologic and PCR methods. One patient was positive for T whippelii in the peripheral blood. Control synovial fluid specimens from 40 patients with other arthritides, including Lyme arthritis, were negative. Sequencing of a 284-basepair region of the 16S ribosomal RNA gene confirmed that the sequence is closely related to the known T whippelii sequence. Both patients responded to treatment with antibiotics. (+info)Infection by Rhodococcus equi in a patient with AIDS: histological appearance mimicking Whipple's disease and Mycobacterium avium-intracellulare infection. (3/147)
Rhodococcus equi pneumonia with systemic dissemination is being reported increasingly in immunocompromised patients. This is the first case report of disseminated R equi infection with biopsy documented involvement of the large intestine. The patient was a 46 year old male with AIDS who was diagnosed with cavitating pneumonia involving the left lower lobe. R equi was isolated in culture from the blood and lung biopsies. Subsequently, the patient developed anaemia, diarrhoea, and occult blood in the stool. Colonoscopy revealed several colonic polyps. Histological examination of the colon biopsies showed extensive submucosal histiocytic infiltration with numerous Gram positive coccobacilli and PAS positive material in the histiocytes. Electron microscopy showed variably shaped intrahistiocytic organisms which were morphologically consistent with R equi in the specimen. Disseminated R equi infection may involve the lower gastrointestinal tract and produce inflammatory polyps with foamy macrophages which histologically resemble those seen in Whipple's disease and Mycobacterium avium-intracellulare infection. (+info)Hypertrophic osteoarthropathy can indicate recurrence of Whipple's disease. (4/147)
We report the case of a patient with Whipple's disease (WD) who developed hypertrophic osteoarthropathy (HOA) characterized by digital clubbing, periostosis of the tubular bones, and polysynovitis. The HOA disclosed the recurrence of the patient's WD, since polymerase chain reaction (PCR) analysis clearly demonstrated the presence of Tropheryma whippelii in the synovial fluid from the patient's left knee. Initiation of appropriate antibiotic therapy resulted in complete healing of all clinical rheumatologic manifestations within 2 months and in disappearance of radiographic bone changes at 7-month followup. We suggest that HOA be included within the spectrum of rheumatologic manifestations of WD, and that an evaluation for WD should be considered in patients, especially middle-aged men, presenting with HOA even without gastrointestinal symptoms. PCR analysis may be useful in accurate diagnosis and management of early WD with unusual clinical manifestations, and may contribute to decreased morbidity and mortality. (+info)Detection of three different types of 'Tropheryma whippelii' directly from clinical specimens by sequencing, single-strand conformation polymorphism (SSCP) analysis and type-specific PCR of their 16S-23S ribosomal intergenic spacer region. (5/147)
The 16S-23S rDNA intergenic spacer region of organisms identical with or closely related to 'Tropheryma whippelii', the uncultivated causative agent of Whipple's disease, was analysed directly from 38 clinical specimens of 28 patients using a specific nested PCR followed by direct sequencing. As compared to the reference sequence in public databases, two novel 'T. whippelii' spacer types were recognized. In the absence of DNA-DNA hybridization data it is uncertain whether the three types found represent subtypes of a single species or three different but closely related species. Methods were developed to detect all three variants by single-strand conformation polymorphism analysis and by type-specific PCR assays, thus allowing the screening of large numbers of specimens. Further studies may provide a clue to the possible associations between the type of infecting strain and the various clinical presentations of Whipple's disease. (+info)Evaluation of a specific nested PCR targeting domain III of the 23S rRNA gene of "Tropheryma whippelii" and proposal of a classification system for its molecular variants. (6/147)
"Tropheryma whippelii"-associated infections are usually confirmed histopathologically by using light microscopy. PCR assays targeting the 16S rRNA gene (16S rDNA) of "T. whippelii" are increasingly being applied for this purpose. Compared to microscopic analysis, PCR seems to be more sensitive, as indicated by the fact that several cases of Whipple's disease with negative histopathological findings but positive PCR results have been reported. Considering the lack of pathognomonic clinical features for this disease and the fact that "T. whippelii" DNA has repeatedly been found in patients without clinical Whipple's disease, such PCR results should be confirmed by additional tests. We have, therefore, evaluated a "T. whippelii"-specific nested PCR targeting domain III of the 23S rDNA with 41 clinical specimens known to contain "T. whippelii" 16S rDNA. All of these specimens were also positive for "T. whippelii" 23S rDNA. The specificity of the test was shown by sequencing of the amplicons and by the absence of amplicons in 38 negative controls. We consider this PCR test to be a suitable tool for confirming the presence of "T. whippelii" DNA in specimens with inconclusive histopathological findings. The information derived from sequencing of the partial "T. whippelii" 23S rDNA was then combined with our recent data of the 16S-23S rDNA spacer region of this organism. Overall, four different rDNA types are recognized in our proposed classification system for molecular variants of "T. whippelii." This preliminary scheme may provide a basis for further epidemiological and clinical studies with "T. whippelii" and associated diseases. (+info)Cultivation of the bacillus of Whipple's disease. (7/147)
BACKGROUND: Whipple's disease is a systemic bacterial infection, but to date no isolate of the bacterium has been established in subculture, and no strain of this bacterium has been available for study. METHODS: Using specimens from the aortic [corrected] valve of a patient with endocarditis due to Whipple's disease, we isolated and propagated a bacterium by inoculation in a human fibroblast cell line (HEL) with the use of a shell-vial assay. We tested serum samples from our patient, other patients with Whipple's disease, and control subjects for the presence of antibodies to this bacterium. RESULTS: The bacterium of Whipple's disease was grown successfully in HEL cells, and we established subcultures of the isolate. Indirect immunofluorescence assays showed that the patient's serum reacted specifically against the bacterium. Seven of 9 serum samples from patients with Whipple's disease had IgM antibody titers of 1:50 or more, as compared with 3 of 40 samples from the control subjects (P<0.001). Polyclonal antibodies against the bacterium were generated by inoculation of the microorganism into mice and were used to detect bacteria in the excised cardiac tissue from our patient on immunohistochemical analysis. The 16S ribosomal RNA gene of the cultured bacterium was identical to the sequence for Tropheryma whippelii identified previously in tissue samples from patients with Whipple's disease. The strain we have grown is available in the French National Collection. CONCLUSIONS: We cultivated the bacterium of Whipple's disease, detected specific antibodies in tissue from the source patient, and generated specific antibodies in mice to be used in the immunodetection of the microorganism in tissues. The development of a serologic test for Whipple's disease may now be possible. (+info)Organization, structure, and variability of the rRNA operon of the Whipple's disease bacterium (Tropheryma whippelii). (8/147)
Whipple's disease is a systemic disorder associated with a cultivation-resistant, poorly characterized actinomycete, Tropheryma whippelii. We determined a nearly complete rRNA operon sequence of T. whippelii from specimens from 3 patients with Whipple's disease, as well as partial operon sequences from 43 patients. Variability was observed in the 16S-23S rRNA spacer sequences, leading to the description of five distinct sequence types. One specimen contained two spacer sequence types, raising the possibility of a double infection. Secondary structure models for the primary rRNA transcript and mature rRNAs revealed rare or unique features. (+info)Whipple disease is a rare, systemic disorder caused by the bacterium Tropheryma whipplei. The condition primarily affects the gastrointestinal (GI) tract, leading to malabsorption and various digestive symptoms. The bacteria are ingested and then invade the small intestine's lining, where they disrupt nutrient absorption and cause widespread inflammation.
The classic symptoms of Whipple disease include diarrhea, weight loss, abdominal pain, and arthralgia or joint pain. Other possible manifestations may involve the cardiovascular system, central nervous system (CNS), lungs, kidneys, eyes, skin, and endocrine system.
The diagnosis of Whipple disease typically involves a combination of clinical symptoms, radiologic findings, and laboratory tests. The gold standard for diagnosing Whipple disease is the detection of Tropheryma whipplei in biopsy samples taken from the small intestine. This can be done through various methods such as polymerase chain reaction (PCR), immunohistochemistry, or electron microscopy.
Untreated Whipple disease can lead to severe complications and even be fatal. However, with appropriate antibiotic therapy, the prognosis is generally good. Long-term antibiotic treatment is typically required to ensure complete eradication of the bacteria and prevent relapses.
"Tropheryma" is a genus of bacteria that includes the species "Tropheryma whipplei," which is the causative agent of Whipple's disease, a rare systemic infection that primarily affects the small intestine. The bacteria are gram-positive, rod-shaped, and have a unique ability to survive and replicate within human host cells, contributing to their pathogenicity. Infection typically occurs through the ingestion of contaminated food or water, and symptoms can include diarrhea, abdominal pain, weight loss, and various other systemic manifestations.
Actinobacteria are a group of gram-positive bacteria that are widely distributed in nature, including in soil, water, and various organic substrates. They are characterized by their high G+C content in their DNA and complex cell wall composition, which often contains mycolic acids. Some Actinobacteria are known to form branching filaments, giving them a characteristic "actinomycete" morphology. Many species of Actinobacteria have important roles in industry, agriculture, and medicine. For example, some produce antibiotics, enzymes, and other bioactive compounds, while others play key roles in biogeochemical cycles such as the decomposition of organic matter and the fixation of nitrogen. Additionally, some Actinobacteria are pathogenic and can cause diseases in humans, animals, and plants.
The duodenum is the first part of the small intestine, immediately following the stomach. It is a C-shaped structure that is about 10-12 inches long and is responsible for continuing the digestion process that begins in the stomach. The duodenum receives partially digested food from the stomach through the pyloric valve and mixes it with digestive enzymes and bile produced by the pancreas and liver, respectively. These enzymes help break down proteins, fats, and carbohydrates into smaller molecules, allowing for efficient absorption in the remaining sections of the small intestine.
Pancreaticoduodenectomy, also known as the Whipple procedure, is a complex surgical operation that involves the removal of the head of the pancreas, the duodenum (the first part of the small intestine), the gallbladder, and the distal common bile duct. In some cases, a portion of the stomach may also be removed. The remaining parts of the pancreas, bile duct, and intestines are then reconnected to allow for the digestion of food and drainage of bile.
This procedure is typically performed as a treatment for various conditions affecting the pancreas, such as tumors (including pancreatic cancer), chronic pancreatitis, or traumatic injuries. It is a major surgical operation that requires significant expertise and experience to perform safely and effectively.
Duodenal neoplasms refer to abnormal growths in the duodenum, which is the first part of the small intestine that receives digestive secretions from the pancreas and bile duct. These growths can be benign or malignant (cancerous).
Benign neoplasms include adenomas, leiomyomas, lipomas, and hamartomas. They are usually slow-growing and do not spread to other parts of the body. However, they may cause symptoms such as abdominal pain, bleeding, or obstruction of the intestine.
Malignant neoplasms include adenocarcinomas, neuroendocrine tumors (carcinoids), lymphomas, and sarcomas. They are more aggressive and can invade surrounding tissues and spread to other parts of the body. Symptoms may include abdominal pain, weight loss, jaundice, anemia, or bowel obstruction.
The diagnosis of duodenal neoplasms is usually made through imaging tests such as CT scans, MRI, or endoscopy with biopsy. Treatment depends on the type and stage of the tumor and may include surgery, chemotherapy, radiation therapy, or a combination of these modalities.
A pancreatectomy is a surgical procedure in which all or part of the pancreas is removed. There are several types of pancreatectomies, including:
* **Total pancreatectomy:** Removal of the entire pancreas, as well as the spleen and nearby lymph nodes. This type of pancreatectomy is usually done for patients with cancer that has spread throughout the pancreas or for those who have had multiple surgeries to remove pancreatic tumors.
* **Distal pancreatectomy:** Removal of the body and tail of the pancreas, as well as nearby lymph nodes. This type of pancreatectomy is often done for patients with tumors in the body or tail of the pancreas.
* **Partial (or segmental) pancreatectomy:** Removal of a portion of the head or body of the pancreas, as well as nearby lymph nodes. This type of pancreatectomy is often done for patients with tumors in the head or body of the pancreas that can be removed without removing the entire organ.
* **Pylorus-preserving pancreaticoduodenectomy (PPPD):** A type of surgery used to treat tumors in the head of the pancreas, as well as other conditions such as chronic pancreatitis. In this procedure, the head of the pancreas, duodenum, gallbladder, and bile duct are removed, but the stomach and lower portion of the esophagus (pylorus) are left in place.
After a pancreatectomy, patients may experience problems with digestion and blood sugar regulation, as the pancreas plays an important role in these functions. Patients may need to take enzyme supplements to help with digestion and may require insulin therapy to manage their blood sugar levels.
The ampulla of Vater, also known as hepatopancreatic ampulla, is a dilated portion of the common bile duct where it joins the main pancreatic duct and empties into the second part of the duodenum. It serves as a conduit for both bile from the liver and digestive enzymes from the pancreas to reach the small intestine, facilitating the digestion and absorption of nutrients. The ampulla of Vater is surrounded by a muscular sphincter, the sphincter of Oddi, which controls the flow of these secretions into the duodenum.
Common bile duct neoplasms refer to abnormal growths that can occur in the common bile duct, which is a tube that carries bile from the liver and gallbladder into the small intestine. These growths can be benign or malignant (cancerous).
Benign neoplasms of the common bile duct include papillomas, adenomas, and leiomyomas. Malignant neoplasms are typically adenocarcinomas, which arise from the glandular cells lining the duct. Other types of malignancies that can affect the common bile duct include cholangiocarcinoma, gallbladder carcinoma, and metastatic cancer from other sites.
Symptoms of common bile duct neoplasms may include jaundice (yellowing of the skin and eyes), abdominal pain, dark urine, and light-colored stools. Diagnosis may involve imaging tests such as CT scans or MRCP (magnetic resonance cholangiopancreatography) and biopsy to confirm the type of neoplasm. Treatment options depend on the type and stage of the neoplasm and may include surgery, radiation therapy, chemotherapy, or a combination of these approaches.