Whipple’s disease infection surgical treatment: presentation of a rare case and literature review

Amendolara, Mauro and Barbarino, Calogero and Bucca, Domenico and Stevanato, Giorgio and Zucchelli, M. and Romano, Fabio and Baiano, L. and Bernardi, M. and Broggiato, A. and Ramuscello, S. and Rizzo, Marta (2013) Whipple’s disease infection surgical treatment: presentation of a rare case and literature review. Il giornale di chirurgia, 34 (4). pp. 117-121. ISSN 1971-145X

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Abstract

The Whipple’ Disease (W.D.) is a very rare disease with an incidence of 1 per 1.000.000 inhabitants; it is a systemic infection that may mimic a wide spectrum of clinical disorders, which may have a fatal outcome and affects mainly male 40-50 years old. The infective agent is an actinomycete, Tropheryma Whipplei (T.W.) that was isolated 100 years after first description by Wipple, and identified in macrophages of mucosa of the small intestine by biopsy which is characterized by periodic acid-Schiff-positive, products of the inner membrane of his polysaccharide bacterial cell wall. The multisystemic clinical manifestations evolve rapidly towards an organic decay characterized by weight loss, malabsorption, diarrhea, polyathralgia, opthalmoplegia, neuro-psychiatric disorders and sometimes associated to endocarditis. Early antibiotic treatment with trimethoprim and sulfometathaxazole reduces the fatal evolution of the disease. The authors present a rare experience about a female subject in which the clinical gastrointestinal signs were preceded by neuro-psychiatric disorders, and evolved into obstruction and intestinal perforation which required an emergency surgery with temporary ileostomy, recanalized only after adequate medical treatment with a full dose of antibiotic and resolution of clinical disease for the high risks of fistulae for the edema and lymphadenopathy of mucosa. The diagnosis was histologically examined by intestinal biopsy performed during surgery, which showed PAS-positive histiocytes, while PRC polymerase RNA was negative, which confirms the high sensibility of PAS positive and low specificity of RNA polymerase for T.W.

Item Type:	Article
Uncontrolled Keywords:	Wipple’s Disease, Tropheryma Whipplei, Surgical treatment Ileostomy
Subjects:	600 Tecnologia - Scienze applicate > 610 Medicina e salute (Classificare qui la tecnologia dei servizi medici) > 617 Rami vari della medicina; Chirurgia
Depositing User:	Nadia Del Gobbo
Date Deposited:	27 Oct 2016 08:59
Last Modified:	27 Oct 2016 08:59
URI:	http://eprints.bice.rm.cnr.it/id/eprint/8404

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