With the timely initiation of antibacterial, hormonal and nutrient-deficient therapy, Whipple's disease has a favorable prognosis.

If there is no treatment, and the symptoms of the disease progress, then patients may die after 2 years from the onset of the second stage of this disease. Whipple's disease is treated by a gastroenterologist.

However, at the first stage of the disease, when the joints become inflamed, the patient can turn to a rheumatologist, who should also be aware of this disease.

In severe cases, the help of specialized specialists is required: a neurologist, a cardiologist, a pulmonologist, a dermatologist, an ophthalmologist. During treatment, it is useful to get detailed advice from a nutritionist. Whipple's disease - description, causes, symptoms (signs), diagnosis, treatment. Whipple's disease is a systemic disease in which the small intestine is involved in the pathological process, but any system of the body can be affected. Over 300 cases of imuran have been described. In 80% of cases, men aged 40–50 years are ill.

Code according to the international classification of diseases ICD-10: K90.8 Other malabsorption in the intestine.

The leading syndrome is diarrhea. Stools are plentiful, light, sometimes chile, up to 10 r/day. A large amount of neutral fat, fatty acids, soap is found in the stool. Non-localized abdominal pain. In 2/3 of patients, the disease begins with articular manifestations (migratory polyarthritis). Persistent deformity of the joints is rare. Often (in 33–50% of patients) fever, general weakness are observed. The disease is accompanied by weight loss. The detailed clinical picture is determined by the main symptoms of azathioprine pills - diarrhea and malnutrition. On objective examination: usually an increase in the abdomen, in half patients - soreness in the mesogastrium. Enlarged painless mobile peripheral and mesenteric lymph nodes can be palpated, less often the spleen.

Surface antigens of bacilli are identical to human tissue antigens, therefore, the immune reaction to them does not develop, which leads to a state of immune tolerance.
This is evidenced by the presence of bacteria in the tissue long before the onset of clinical symptoms, as well as the absence of pronounced lymphoplasmacytic infiltration of the mucous membrane and specific serum antibodies to bacteria.
Panmalabsorption in Whipple's disease is explained by the compression of macrophage infiltrate of the lymphatic vessels of the villi, which disrupts the transport of absorbed substances.
Whipple's disease (syn. Whipple's disease, Whipple's disease, mesenteric lipogranulomatosis, lipophagic intestinal granulomatosis, intestinal lipodystrophy, intestinal lipodystrophy) is a rather rare systemic pathology in which the small intestine is most often affected. As the pathological process progresses, the organs of the digestive, nervous and cardiovascular systems may be involved.
It is often expressed by fever, stool disorder, productive cough, convulsive seizures and decreased visual acuity.
The causative agent of the disease is the bacterium Tropheryma whippelii, little studied to date. The main provoking factor of azathioprine is considered to be a decrease in the resistance of the immune system. The clinical picture will be dominated by symptoms from the affected organ or system.

Diagnosis of Whipple's disease must necessarily have an integrated approach.

Laboratory tests are necessary to identify the pathogen, and instrumental procedures to determine the degree of damage to internal organs. The tactics of therapy is conservative in nature and consists in taking medications and observing a sparing diet. It should be noted that the treatment takes a long period of time, on average - 2 years. Modern researchers believe that the disease develops due to the penetration of azathioprine microorganisms into the human body - Tropheryma whippelii.

After infection, the bacteria actively increase in numbers in immune cells, which are called macrophages.

Clinical manifestations develop in both adults and children. It must be remembered that the severity of symptoms in a child can be much higher than in middle-aged or older people. As additional diagnostic measures, in order to diagnose Whipple's disease, consultations with such specialists are needed. The elimination of Whipple's disease takes a rather long period of time and involves the use of only conservative therapeutic methods. Frequent and fractional food intake is recommended. All rules regarding the diet, sample menu, list of prohibited and permitted foods are provided only by the attending physician.

The symptoms and treatment of Whipple's disease affect the prognosis, which is considered conditionally favorable. This is due to the fact that it is impossible to completely cure the disease, however, compliance with therapeutic rules can help achieve long-term remission.

  • It is worth noting that without qualified assistance, people die a few years after the onset of intestinal clinical manifestations. Tocomplications can lead to death.
  • In some cases, the organs of vision are affected.
  • Whipple's disease (mesenteric lipogranulomatosis or intestinal lipodystrophy) is a rare systemic disease of an infectious nature, in which there are violations of cellular and humoral immunity.
  • The causative agent of the disease primarily affects the small intestine, also affecting the mesenteric lymph nodes and synovial membranes of the joints.
  • As the disease progresses, other organs are also involved in the pathological process.

For the first time this disease was described in 1907 by the American pathologist George Whipple. Clinical manifestations of imuran pills included severe diarrhea, steatorrhea, severe weight loss, and anemia, and at autopsy, Whipple found significantly enlarged mesenteric lymph nodes and polyserositis (inflammation of the serous membranes).

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Since histological examination of the intestine and lymph nodes revealed diffuse accumulation of lipids and the presence of many rod-shaped organisms on Levadity stain, Whipple suggested two causes of the disease. George Whipple himself did not return to the study of this disease, and the next study on this topic appeared only 23 years later. In 1949, when examining biopsies of mesenteric lymph nodes and the small intestine, PAS were identified - positive macrophages, in which there were inclusions resembling bacterial decay products.

By 1950, 15 papers had been published in which various bacteria isolated in culture from a biopsy were declared the causative agent of the disease. In honor of George Whipple, the isolated pathogen was named Tropheryma whipplii.

The disease is rare - by 1988, data on 1000 cases of the disease were recorded. Whipple's disease affects predominantly men (30:1) of the Caucasian race, and the age of most patients is 40–50 years.

The disease is usually detected in people who come into contact with the earth and animals.

Stage I, in which extraintestinal manifestations are observed (the temperature rises in most cases to 37.5-38.5 ° C, joints and lymph nodes are affected); Stage II, in which pronounced intestinal dysfunction is manifested (digestion is disturbed, vitamin deficiency begins and body weight rapidly decreases); Stage III, which is accompanied by damage to the nervous and cardiovascular systems and polyserositis.

It has now been established that Whipple's disease is infectious in nature, and its most likely causative agent is the little-studied bacterium Tropheryma whippelii.


In most cases, these gram-positive bacteria are found inside macrophages, but they also occur in the extracellular space. The main distinguishing feature of this bacterium is the three-layered cell wall, which is clearly visible under electron microscopy.


According to morphological and phylogenetic features, Tropheryma whippelii belongs to actinomycetes - bacteria that: are able to form branching mycelium at some stages of their development; characterized by an acid-resistant type of imuran online, which according to Gram stains as gram-positive, but is close to gram-negative in structure; characterized by a high content of GC pairs in DNA.


According to the researchers, Tropheryma whippelii penetrates macrophages and multiplies there. In healthy people, macrophages destroy infectious agents, but in Whipple's disease, the bacteria remain intact. Since Tropheryma whippelii has been detected in the saliva of a number of people without any symptoms of the disease, it is assumed that the development of the disease is also influenced by the state of immunity.


According to the researchers, the production of antibodies to the causative agent of Whipple's disease is completely absent or very low, so the incidence is associated with a cellular immune response.

Simple Process

How Does it Work?

Despite the fact that Whipple's disease is infectious in nature, there are currently no exact data regarding the duration of the incubation period.

Step 1:

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Stage 1 - extraintestinal symptoms appear. Often only one system is affected, such as the joints or lymph nodes. The main symptom is constantly elevated body temperature. Stage 2 - there is a development of a violation of the course of digestion processes and the occurrence of consequences associated with this, for example, stool disorder and a sharp decrease in body weight. Stage 3 - there is involvement in the pathology of various internal organs, among which may be the heart, lungs, nervous system.

Step 2:

It should be noted that the main risk group is people aged 40-50 years, but the possibility of developing the disease in people of a different age category is not excluded. It is noteworthy that men are most often affected by this type of infection.

In addition to the infectious cause, the reaction of the body plays an important role in the development of the disease. The main predisposing factors: decreased immunity; helminthic invasions; chronic problems with the gastrointestinal tract; lack of adequate nutrition.

Step 3:

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Further exacerbating the problem are changes in the absorption of vitamins, minerals and other nutrients. Then the pathological process spreads to the intra-abdominal lymph nodes, myocardium and pericardium, joints and abdominal cavity, pleura and brain. Clinicians have found that in some healthy people, that is, in the absence of characteristic signs of the disease, the bacterium can be excreted with saliva.

Structurally altered macrophages begin to accumulate in the mucous membrane of the small intestine, which leads to a sharp decrease in nutrient absorption. This is due to the fact that their transport is interrupted at the level of the intestine, and fat deposits (lipodystrophy) form in the shell.

In a healthy person, they perform the function of absorbing and destroying infectious agents, but in this situation, the bacilli remain unharmed.