title: Whipple's disease: new aspects of pathogenesis and treatment.
abstract: 100 years after its first description by George H Whipple, the diagnosis and treatment of Whipple's disease is still a subject of controversy. Whipple's disease is a chronic multisystemic disease. The infection is very rare, although the causative bacterium, Tropheryma whipplei, is ubiquitously present in the environment. We review the epidemiology of Whipple's disease and the recent progress made in the understanding of its pathogenesis and the biology of its agent. The clinical features of Whipple's disease are non-specific and sensitive diagnostic methods such as PCR with sequencing of the amplification products and immunohistochemistry to detect T whipplei are still not widely distributed. The best course of treatment is not completely defined, especially in relapsing disease, neurological manifestations, and in cases of immunoreconstitution after initiation of antibiotic treatment. Patients without the classic symptoms of gastrointestinal disease might be misdiagnosed or insufficiently treated, resulting in a potentially fatal outcome or irreversible neurological damage. Thus, we suggest procedures for the improvement of diagnosis and an optimum therapeutic strategy.
authors.affiliation: Medical Department I, Charité-University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schneider
authors.forename: Verena
authors.initials: V
authors.lastname: Moos
authors.forename: Christoph
authors.initials: C
authors.lastname: Loddenkemper
authors.forename: Thomas
authors.initials: T
authors.lastname: Marth
authors.forename: Florence
authors.initials: F
authors.lastname: Fenollar
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
mesh_terms: D006801:Humans; D054851:Tropheryma / Q000472:pathogenicity*; D008061:Whipple Disease / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology