MFF0038: Whipple’s disease

Medical Fun Facts logo from Gary Lum

If I’ve timed this correctly, tonight’s show is dropping on Thursday 09 February 2017 and it’s payday!

Tonight’s episode is about something beginning with the letter W. So what is Whipple’s disease?

Whipple’s disease, that’s Whipple’s with a capital W and an apostrophe s, is a fairly uncommon infectious disease caused by the bacterium Tropheryma whipplei. This bacterium is an actinomycete, and although most actinomycetes are Gram-positive, this bacterium often stains Gram-negative or Gram-indeterminate. Nobel laureate, George Hoyt Whipple probably saw them using a silver-based stain.

The disease was first described in 1907 by as you can guess George Whipple. His disease mainly causes malabsorption, but it can affect many other systems including the heart, brain, joints, skin, eyes and lungs.

Whipple’s disease commonly presents with weight loss, diarrhoea, and joint pain associated with inflammation of the joints. Not all patients have these typical presenting signs and symptoms.

The disease occurs mostly in men, and if untreated is usually fatal.

The malabsorption which can arise years after the joint pain can lead to wasting. Along with the wasting, lymph nodes in the abdomen become enlarged. Neurological symptoms become worse in patients with the severe abdominal disease.

Chronic diarrhoea occurs because of poor fat absorption and this leads to fatty foul offensive stools, a lot of farting and abdominal distension. With changes in the gut, protein is lost via the gut and this causes a fall in albumin in the blood which then leads to peripheral œdema or puffy swelling in the extremities.

Fifty per cent of patients develops hyperpigmented skin, some with skin nodules.

The aforementioned neurological problems include dementia, memory loss, confusion, and altered consciousness.

The causative bacterium is probably environmental in origin. The diagnosis is made when patients present with the tell-tale symptoms and an astute medical practitioner arranges histopathology of biopsy specimens and PCR testing looking for the causative bacterium.

Treatment is with relatively simple antimicrobials for anything up to 2 years.

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