Hla antigens in whipple's disease

Dobbins, William O.

doi:10.1002/art.1780300115

Cited by 70 publications

(79 citation statements)

References 14 publications

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“…Related organisms have known environmental habitats. The epidemiological observation of a high frequency of farmers and carpenters among those with Whipple's disease is also supportive (8). The organism has been identified recently in specimens from sewage treatment plants (16).…”

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confidence: 82%

“…These defects are found not only in those with acute disease but also in those in remission. Difficulty in phagocytosis or degradation of the intracellular Gram-positive bacteria has been described as well (8,14). The hypothesis of a possible cell-mediated macrophage activation defect is supported by experiments (15) in which phagocytes deactivated with IL-4 (also IL-10 and dexamethasone) were rendered to be permissive to intracellular T whippelii propagation.…”

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confidence: 96%

“…Deaths from Whipple's disease are usually a result of failure to diagnose the disease, lack of antibiotic treatment, or delayed initiation of treatment with central nervous system (CNS) or cardiac complications. Of the 676 patients analyzed, 97% were white and two-thirds were farmers, construction workers or machinists (8). The reported age range varies widely (one to 81 years), but the disease appears to affect primarily middle-aged to elderly males.…”

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confidence: 99%

“…There is no accurate estimate of either the prevalence or death rate because of this low incidence rate. Dobbins (8) analyzed 676 patients and found fewer than 18 cases/year in the 1960s and 30/year in the 1980s; however, the population also doubled between these time periods. Deaths from Whipple's disease are usually a result of failure to diagnose the disease, lack of antibiotic treatment, or delayed initiation of treatment with central nervous system (CNS) or cardiac complications.…”

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confidence: 99%

“…All of the clinical eye manifestations are nonspecific, including glaucoma, chemosis, retinal hemorrhage, papilledema, fibrovascular pannus, corneal ulcers, optic atrophy and epiphora. From a diagnostic viewpoint, clinicians should include Whipple's disease in the differential diagnosis of patients with chronic bilateral retinitis and vitritis, especially if these disorders are associated with CNS manifestations (8).…”

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confidence: 99%

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Rare but Not so Rare? The Evolving Spectrum of Whipple′s Disease

Conly

2001

Canadian Journal of Infectious Diseases and Medical Microbiolog

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Knowledge about Whipple's disease began to emerge in 1907, when George Hoyt Whipple recognized the first case of the disease that now bears his name. He reported the case of a 36-year-old physician with "a gradual loss of weight and strength, stools consisting chiefly of neutral fat and fatty acids, indefinite abdominal signs, and a peculiar multiple arthritis" (1). Findings at autopsy consisted of poly-serositis, aortic valve vegetations and deposition of fat in the intestinal mucosa and regional lymph nodes with marked infiltration by foamy macrophages (1). It was originally thought to be a disorder of fat metabolism, and the term 'intestinal lipodystrophy' was proposed. Whipple's disease has since been recognized as a rare, multivisceral, chronic disease with a clinical presentation dominated by a symptom triad of diarrhea, weight loss and malabsorption. However, digestive symptoms are often preceded for months or years by other symptoms, the most common being arthralgia, although cardiovascular, neurological or pulmonary involvement may be more prominent at times. Once considered the ideal case report, recent characterization ofTropheryma whippeliiby means of broad range bacterial ribosomal DNA polymerase chain reaction (PCR) analysis (2,3) and its subsequent cultivation (4) has led to a veritable explosion of individual case reports, case series and hitherto unrecognized manifestations of the disease, such that it is now considered an underdiagnosed infectious disease (5). It is timely to provide an update on new developments in Whipple's disease.

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confidence: 82%

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confidence: 96%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Rare but Not so Rare? The Evolving Spectrum of Whipple′s Disease

Conly

2001

Canadian Journal of Infectious Diseases and Medical Microbiolog

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Cognitive and Behavioral Abnormalities in a Case of Central Nervous System Whipple Disease

Manzel

Tranel²,

Cooper³

2000

Arch Neurol

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Fever, Diarrhea, and Weight Loss in a Man With Inflammatory Polyarthritis

Sondhi

Platt

Gupta

2020

JAMA

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A 61-year-old white man with seronegative rheumatoid arthritis presented with hand and wrist pain. Over 2 years, he was prescribed various therapies including prednisone, methotrexate, tumor necrosis factor inhibitors, abatacept, and anakinra; he experienced intermittent improvement in his joint pain but had persistently elevated levels of inflammatory markers. He continued to experience asymmetric small-and large-joint polyarthralgias and later developed intermittent fevers (temperatures up to 38.3°C [101°F]) along with a 50-lb (22.7-kg) unintentional weight loss over the course of a few months.On examination, there was subtle synovitis in bilateral metacarpophalangeal joints. Findings on cardiac, pulmonary, and neurologic examinations were unremarkable. Laboratory evaluation was notable for a normocytic anemia and elevated C-reactive protein level (7.7 mg/dL [73.3 nmol/L]). Results of esophagogastroduodenoscopy with gastric biopsies and bone marrow biopsy were unremarkable. Findings on further workup including transthoracic echocardiography to assess for endocarditis, carotid magnetic resonance angiography to assess for vasculitis, and abdominal fat pad biopsy for amyloidosis were also unremarkable. Tocilizumab was initiated. Over the next several months, he developed intermittent abdominal pain, steatorrhea, protein-losing enteropathy, and symmetric bilateral lower extremity edema requiring diuresis. Results of infectious stool studies, celiac serology, and fecal elastase testing were normal. Repeat esophagogastroduodenoscopy (Figure , panel A) was performed, with gastric and duodenal biopsies (Figure, panels B and C).

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Hla antigens in whipple's disease

Cited by 70 publications

References 14 publications

Rare but Not so Rare? The Evolving Spectrum of Whipple′s Disease

Rare but Not so Rare? The Evolving Spectrum of Whipple′s Disease

Cognitive and Behavioral Abnormalities in a Case of Central Nervous System Whipple Disease

Fever, Diarrhea, and Weight Loss in a Man With Inflammatory Polyarthritis

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