Whipple disease and arthritis.

Area of Science:

• Infectious Diseases
• Rheumatology
• Gastroenterology

Background:

• Whipple disease is a chronic, multisystem bacterial infection caused by Tropheryma whippelii.
• It commonly affects middle-aged men, with arthritis preceding gastrointestinal symptoms in most cases.
• Diagnosis can be challenging due to varied clinical manifestations and negative initial jejunum biopsy results.

Purpose of the Study:

• To highlight the importance of clinical suspicion for early Whipple disease diagnosis.
• To discuss the role of new diagnostic tools in identifying Tropheryma whippelii.
• To explore the potential expansion of the clinical spectrum and frequency of Whipple disease.

Main Methods:

• Review of clinical manifestations and diagnostic challenges in Whipple disease.
• Application of polymerase chain reaction (PCR) for Tropheryma whippelii detection in various tissues and fluids.
• Mention of recent cultivation of Whipple bacillus and development of serologic tests.

Main Results:

• Periodic acid-Schiff staining of small bowel biopsies reveals bacterial inclusions in macrophages.
• PCR enables detection of Tropheryma whippelii in early or atypical Whipple disease cases, including synovial tissue.
• Recent advances suggest Whipple disease may be more frequent and present with a broader spectrum of symptoms.

Conclusions:

• Early diagnosis of Whipple disease is crucial and relies on high clinical suspicion, especially in cases of unexplained arthritis.
• Advancements in diagnostic techniques, including PCR and potential serologic tests, facilitate earlier and broader detection of Tropheryma whippelii infections.
• Earlier diagnosis can prevent severe, potentially fatal systemic manifestations of Whipple disease.