Whipple disease
Introduction
Introduction to Whipple's disease Whipple disease is an uncommon chronic bacterial infection with multiple system involvement. Usually involving the small intestine, the symptoms of the gastrointestinal tract are prominent. Typically, the intestinal mucosa is infiltrated by foam macrophages containing periodic acid (PAS) positive substances, and the villi are deformed. Under electron microscopy or high-resolution optical microscopy, bacteria can be seen in the lamina propria, PAS-positive macrophages and bacteria can appear outside the intestine, such as lymph nodes, spleen, liver, central nervous system, heart and synovium. basic knowledge The proportion of illness: 0.0002% Susceptible people: no special people Mode of infection: non-infectious Complications: diarrhea
Cause
Cause of Whipple's disease
Abdominal staining (40%)
In 1961, foreign scholars found that pathogens and macrophages infiltrated in Whipple disease tissues under electron microscope, and pathogens could also be present outside macrophages (such as intestinal epithelial cells, lymphocytes, capillary epithelial cells, smooth muscle cells, Polymorphonuclear granulocytes, plasma cells and mast cells suggest that the disease is an infectious disease. In the 1990s, with the application of PCR technology in biopsy tissues and peripheral blood, it provided a new basis for its infection-causing mechanism. However, the infection, spread form of Tropheryma Whi ppelii and whether it is related to other diseases are still unclear.
Immunogenicity (40%)
In the 1970s, some scholars confirmed that there were immunodeficiencies in T lymphocytes and macrophages in patients with Whipple's disease [15]. Recently, some scholars have found that patients with Whip le disease have decreased IL-12 and -interferon [16] ]; Mahnel et al [17] used -interferon-assisted antibiotics to treat refractory Whipple disease with good results, suggesting that cellular immunity plays a role in the pathogenesis of Whipple disease.
Prevention
Whipple disease prevention
The disease is caused by bacterial infection, and the pathogenic bacteria enters through the mouth. Therefore, attention to food hygiene is the fundamental measure to prevent this disease. Secondly, physical exercise should be strengthened to improve self-immunity.
Complication
Whipple disease complications Complications, diarrhea
Complications such as diarrhea and severe malabsorption often occur, as well as symptoms of heart, liver, and neuropsychiatric disorders.
Symptom
Whipple disease symptoms Common symptoms Abdominal pain Joint pain Low fever Fat splenomegaly diarrhea Lymph node enlargement
The most common symptoms are long-term multiple recurrent arthritis or joint pain. Before the onset of arthritis, some patients have diarrhea, diarrhea gradually, typical intestinal malabsorption symptoms, and individual cases can be free of diarrhea. There is abdominal pain and low fever, and there is swelling of the whole body lymph nodes. A few patients have splenomegaly.
Examine
Whipple disease check
Lymph node biopsy or intestinal mucosal biopsy of foamy macrophages containing glycoprotein (which can be stained with PAS) can establish a diagnosis or a bacterial culture. The jejunal tissue may be normal in other aspects or may have a bundle of cortical bundles and lymphatic vessels. Even the villus is partially atrophied. Electron microscopy shows that the PAS-positive substance is a bunch of rod-shaped bacteria.
Diagnosis
Diagnosis of Whipple disease
Long-term joint pain accompanied by diarrhea, or systemic lymphadenopathy at the same time, should consider the possibility of this disease, xylose test has absorption function impairment, small intestinal mucosal biopsy has PAS-positive substances, electron microscopy confirmed that there are sputum particles can make a diagnosis Should pay attention to the exclusion of AIDS (AIDS), macroglobulinemia and systemic reticuloendotheliosis.
The disease is mainly differentiated from inflammatory bowel disease, AIDS, macroglobulinemia, and systemic reticuloendotheliosis.
