Whipple's disease
Definition :
Whipple's disease is a rare bacterial infection that most often affects
your gastrointestinal system. Whipple's disease interferes with normal
digestion by impairing the breakdown of foods, such as fats and
carbohydrates, and hampering your body's ability to absorb nutrients.
Whipple's disease also can infect other organs, including your brain, heart, joints and eyes.
Without proper treatment, Whipple's disease can be serious or fatal. However, a course of antibiotics can treat Whipple's disease.
Symptoms:
Common signs and symptoms
Gastrointestinal signs and symptoms are common in Whipple's disease and may include:
In some cases, signs and symptoms of Whipple's disease may include:
When to see a doctor
Whipple's disease is potentially life-threatening, yet usually treatable. Contact your doctor if you experience unusual signs or symptoms, such as unexplained weight loss or joint pain. Your doctor can perform tests to determine the cause of your symptoms.
Even after the infection is diagnosed and you're receiving treatment, let your doctor know if your symptoms don't improve. Sometimes antibiotic therapy isn't effective because the bacteria are resistant to the particular drug you're taking. The disease can recur, so it's important to watch for the re-emergence of symptoms.
Causes:
The cause of Whipple's disease is infection with the bacterium Tropheryma whipplei. This bacterium initially affects the mucosal lining of your small intestine, forming small lesions within the intestinal wall. The bacterium also damages the fine, hair-like projections (villi) that line the small intestine. With time, the infection can spread to other parts of your body.
Not much is known about the bacterium. Although it seems readily present in the environment, scientists don't really know where it comes from or how it's transmitted to humans. Not everyone who carries the bacterium develops the disease. Some researchers believe that people with the disease may have a genetic defect in their immune system response that makes them more susceptible to becoming ill when exposed to the bacterium.
Whipple's disease is extremely uncommon.
Complications:
The lining of your small intestine has fine, hair-like projections (villi) that help your body absorb nutrients. Whipple's disease damages the villi, impairing nutrient absorption. Nutritional deficiencies are common in people with Whipple's disease and can lead to fatigue, weakness, weight loss and joint pain.
Whipple's disease is a progressive and potentially fatal disease. Although the infection is rare, associated deaths continue to be reported, due in large part to late diagnoses and delayed treatment. Death often is caused by the spread of the infection to the central nervous system, which can cause irreversible damage.
Treatments and drugs:
Treatment of Whipple's disease is with antibiotics, either alone or in combination, which can destroy the bacteria causing the infection.
Treatment is long term, generally lasting a year or two, in an effort to destroy the bacteria. But relief from symptoms typically comes much quicker, often within the first week or two. Most people with no brain or nervous system complications recover completely after a full course of antibiotics.
When choosing antibiotics, doctors often select those that not only wipe out infections of the intestinal tract but also cross the blood-brain barrier — a layer of tissue around your brain — in order to eliminate bacteria that may have entered your brain and central nervous system.
Because of the lengthy use of antibiotics, your doctor will need to monitor your condition for development of resistance to the drugs. If you relapse during treatment, your doctor may change your antibiotics.
Treatment for standard cases
In most cases, Whipple's disease therapy begins with 14 days of intravenous (IV) ceftriaxone (Rocephin). Following that initial therapy, you'll likely take an oral course of sulfamethoxazole-trimethoprim, or SMX- TMP, (Bactrim, Septra), for one to two years. A shorter duration of antibiotic treatment may lead to a relapse.
Possible side effects of ceftriaxone and SMX- TMP include mild diarrhea, nausea and vomiting.
Treatment for severe cases
If you have neurologic symptoms, you may be started immediately on a 12- to 18-month course of oral doxycycline (Vibramycin) combined with the antimalarial drug hydroxychloroquine (Plaquenil). You'll also be given long-term antibiotics that can enter the cerebrospinal fluid and brain, such as TMP-SMX.
Possible side effects of doxycycline include loss of appetite, nausea, vomiting and sensitivity to sunlight. Hydroxychloroquine may cause loss of appetite, diarrhea, headache, stomach cramps and
dizziness.
Symptom relief
Your symptoms should improve within one to two weeks of starting antibiotic treatment and go away entirely within about one month.
But even though symptoms improve quickly, further laboratory tests may reveal presence of the bacteria for two or more years after you begin taking antibiotics. Follow-up testing will help your doctor determine when you can stop taking antibiotics. Regular monitoring can also indicate development of resistance to a particular drug, often reflected in a lack of improvement of your symptoms.
Even after successful treatment, Whipple's disease can recur. Doctors usually advise regular checkups. If you've experienced a recurrence, you'll need to repeat antibiotic therapy.
Taking supplements
Because of the nutrient-absorption difficulties associated with Whipple's disease, your doctor may recommend taking vitamin and mineral supplements to ensure adequate nutrition. Your body may require additional vitamin D, folic acid, calcium, iron and magnesium.
Definition :
Whipple's disease is a rare bacterial infection that most often affects
your gastrointestinal system. Whipple's disease interferes with normal
digestion by impairing the breakdown of foods, such as fats and
carbohydrates, and hampering your body's ability to absorb nutrients.
Whipple's disease also can infect other organs, including your brain, heart, joints and eyes.
Without proper treatment, Whipple's disease can be serious or fatal. However, a course of antibiotics can treat Whipple's disease.
Symptoms:
Common signs and symptoms
Gastrointestinal signs and symptoms are common in Whipple's disease and may include:
- Diarrhea
- Abdominal cramping and pain, which may worsen after meals
- Weight loss, associated with the malabsorption of nutrients
- Inflamed joints, particularly your ankles, knees and wrists
- Fatigue
- Weakness
- Anemia
In some cases, signs and symptoms of Whipple's disease may include:
- Fever
- Cough
- Enlarged lymph nodes
- Skin darkening (hyperpigmentation) in areas exposed to the sun and in scars
- Chest pain
- Enlarged spleen
- Difficulty walking
- Visual impairment, including lack of control of eye movements
- Seizures
- Confusion
- Memory loss
When to see a doctor
Whipple's disease is potentially life-threatening, yet usually treatable. Contact your doctor if you experience unusual signs or symptoms, such as unexplained weight loss or joint pain. Your doctor can perform tests to determine the cause of your symptoms.
Even after the infection is diagnosed and you're receiving treatment, let your doctor know if your symptoms don't improve. Sometimes antibiotic therapy isn't effective because the bacteria are resistant to the particular drug you're taking. The disease can recur, so it's important to watch for the re-emergence of symptoms.
Causes:
The cause of Whipple's disease is infection with the bacterium Tropheryma whipplei. This bacterium initially affects the mucosal lining of your small intestine, forming small lesions within the intestinal wall. The bacterium also damages the fine, hair-like projections (villi) that line the small intestine. With time, the infection can spread to other parts of your body.
Not much is known about the bacterium. Although it seems readily present in the environment, scientists don't really know where it comes from or how it's transmitted to humans. Not everyone who carries the bacterium develops the disease. Some researchers believe that people with the disease may have a genetic defect in their immune system response that makes them more susceptible to becoming ill when exposed to the bacterium.
Whipple's disease is extremely uncommon.
Complications:
The lining of your small intestine has fine, hair-like projections (villi) that help your body absorb nutrients. Whipple's disease damages the villi, impairing nutrient absorption. Nutritional deficiencies are common in people with Whipple's disease and can lead to fatigue, weakness, weight loss and joint pain.
Whipple's disease is a progressive and potentially fatal disease. Although the infection is rare, associated deaths continue to be reported, due in large part to late diagnoses and delayed treatment. Death often is caused by the spread of the infection to the central nervous system, which can cause irreversible damage.
Treatments and drugs:
Treatment of Whipple's disease is with antibiotics, either alone or in combination, which can destroy the bacteria causing the infection.
Treatment is long term, generally lasting a year or two, in an effort to destroy the bacteria. But relief from symptoms typically comes much quicker, often within the first week or two. Most people with no brain or nervous system complications recover completely after a full course of antibiotics.
When choosing antibiotics, doctors often select those that not only wipe out infections of the intestinal tract but also cross the blood-brain barrier — a layer of tissue around your brain — in order to eliminate bacteria that may have entered your brain and central nervous system.
Because of the lengthy use of antibiotics, your doctor will need to monitor your condition for development of resistance to the drugs. If you relapse during treatment, your doctor may change your antibiotics.
Treatment for standard cases
In most cases, Whipple's disease therapy begins with 14 days of intravenous (IV) ceftriaxone (Rocephin). Following that initial therapy, you'll likely take an oral course of sulfamethoxazole-trimethoprim, or SMX- TMP, (Bactrim, Septra), for one to two years. A shorter duration of antibiotic treatment may lead to a relapse.
Possible side effects of ceftriaxone and SMX- TMP include mild diarrhea, nausea and vomiting.
Treatment for severe cases
If you have neurologic symptoms, you may be started immediately on a 12- to 18-month course of oral doxycycline (Vibramycin) combined with the antimalarial drug hydroxychloroquine (Plaquenil). You'll also be given long-term antibiotics that can enter the cerebrospinal fluid and brain, such as TMP-SMX.
Possible side effects of doxycycline include loss of appetite, nausea, vomiting and sensitivity to sunlight. Hydroxychloroquine may cause loss of appetite, diarrhea, headache, stomach cramps and
dizziness.
Symptom relief
Your symptoms should improve within one to two weeks of starting antibiotic treatment and go away entirely within about one month.
But even though symptoms improve quickly, further laboratory tests may reveal presence of the bacteria for two or more years after you begin taking antibiotics. Follow-up testing will help your doctor determine when you can stop taking antibiotics. Regular monitoring can also indicate development of resistance to a particular drug, often reflected in a lack of improvement of your symptoms.
Even after successful treatment, Whipple's disease can recur. Doctors usually advise regular checkups. If you've experienced a recurrence, you'll need to repeat antibiotic therapy.
Taking supplements
Because of the nutrient-absorption difficulties associated with Whipple's disease, your doctor may recommend taking vitamin and mineral supplements to ensure adequate nutrition. Your body may require additional vitamin D, folic acid, calcium, iron and magnesium.
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