Whipple's disease (a.k.a. Tropheryma whippelli) was first discussed in 1907 at the Johns Hopkins University in Baltimore, MD. That publication described a medical missionary who had experienced a five-year history of weight loss, fevers, and diarrhea and abdominal complaints. In addition, the patient had low blood pressure (hypotension), skin pigmentation and anemia (low blood counts).

Eventually, abnormalities of the small bowel were identified. Associated with this disease are the symptoms of arthritis, aortic valve abnormalities and prominent lymph nodes.

Initially, a bacterial infection was thought to be present. The diagnosis of Whipple's disease has been based upon identification of abnormalities in small bowel biopsies (a small rod shaped actinomycete) obtained during endoscopy and the broad number of complaints present in an individual patient. Only recently has this been shown to be a specific organism name Tropheryma whippelli.

Essentially, this disease is a systemic (whole body) infection by a bacteria which the produces various symptoms based upon the organ (or organ systems) infected.

The differential diagnosis includes mycobacteria and sarcoidosis. In fact, Mycobacterium avium intracellularly can appear very similar to the bacteria found in Whipple's disease.

Symptoms of Whipple's Disease are:

	Diarrhea is common but present in all patients.
	Intestinal Bleeding.
	Cramps and abdominal bloating.
	Malnutrition.
	Arthritis.
	Fever.
	Chronic cough.
	Chest pain.
	Congestive Heart Failure.
	Dementia.
	Lethargy.
	Headache.
	Muscle Pain and weakness.

Some organs associated with Whipple's disease are:

	Uveitis (an abnormality of the anterior portion of the eye).
	Retinitis( an irritation of the posterior portion of the eye).
	Lung (associated with infection of the lung).
	Optic nerve.
	Lymphadenopathy.
	Fever of unknown origin (FUO).
	Endocarditis.
	Central nervous system.
	Small Bowel.

Diagnosis:

The diagnostic tests involved are endoscopy with small bowel biopsy and x-rays. Specific studies of potentially infected organ systems can also be used but are reserved for particular symptoms present in a patient. Anemia (most commonly associated with iron loss but sometime the anemia may be secondary to B12 deficiency) and evidence eof malnutrition are commonly identified.

Treatment:

Antibiotic treatment for Whipple's disease includes intravenous penicillin and streptomycin followed by a course of TMP-SMX (Bactrim). The TMP-SMX course is administered by mouth and is continued for one year.

Follow-up:

The PCR test is good for following treatment outcomes. A PCR is a test that measures specific proteins and compounds within the blood. By measuring these proteins regularly, the patient's response to medical therapy can be accurately measured

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