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Whipple's disease frequently causes significant cardiac problems, including inflammation and fibrosis of the heart muscle and valves. Early recognition of cardiac symptoms is crucial for managing this rare bacterial infection.
Area of Science:
- Cardiology
- Infectious Diseases
- Pathology
Background:
- Cardiac involvement in Whipple's disease is often underestimated.
- Previous reports have not emphasized the extent and significance of cardiac manifestations.
Purpose of the Study:
- To investigate the prevalence and characteristics of cardiac involvement in Whipple's disease.
- To highlight the pathological findings and clinical significance of cardiac lesions.
Main Methods:
- Autopsy and histological examination of cardiac tissues from 19 Whipple's disease patients.
- Clinical assessment including physical examination, ECG, and echocardiography.
- Electron microscopy to identify causative microorganisms.
Main Results:
- 58% of patients exhibited clinical cardiac findings; 79% had gross cardiac lesions at autopsy.
- PAS-positive macrophages, inflammation, and fibrosis were observed in the pericardium, myocardium, and valves.
- Cardiac deformities resembled those seen in rheumatic heart disease and idiopathic cardiomyopathy.
- Rod-shaped bacteria, consistent with Tropheryma whipplei, were identified in cardiac tissues.
Conclusions:
- Whipple's disease causes a pancardiopathy with significant structural damage.
- Cardiac involvement is a major feature of Whipple's disease, leading to various clinical manifestations.
- Identification of bacteria in cardiac tissue confirms their role in the observed pathology.
Abstract:
Although cardiac involvement in Whipple's disease has been reported previously, the extent and significance of such involvement has not been stressed. In our series of 19 patients, 58% had clinical cardiac findings and 79% had gross cardiac lesions at autopsy. Histologically there were PAS-positive macrophages in the pericardium, myocardium, and valves of each of these patients. These collections of macrophages were associated with chronic inflammatory cells and foci of fibrosis with resultant adhesive pericarditis, focal myocardial fibrosis similar to the fibrosis of idiopathic cardiomyopathy, and valvular fibrosis with deformity grossly resembling the valvular lesions of chronic rheumatic heart disease. Four of the patients with mitral valvular deformity had cardiac murmurs, and ECG changes were noted in six patients with mitral myocardial fibrosis. In addition, pericardial friction rubs were heard in two patients. By electron microscopy rod-shaped bodies, presumably bacteria, were noted in the mitral valve and myocardium. The structures are identical to those described in the small intestinal mucosa of patients with Whipple's disease and presumably are the causative agent of the pancardiopathy.