Whipple's disease

　　Whipple's disease, also known as Whipple's disease, is an intestinal fat metabolism disorder, with the main causes being abdominal infection and immunogenicity.In 1961, scholars abroad discovered that the pathological tissue of Whipple's disease contains pathogenic bacteria and macrophage infiltration under an electron microscope, and the pathogenic bacteria can also exist outside macrophages (such as in small intestinal epithelial cells, lymphocytes, capillary epithelial cells, smooth muscle cells, polymorphonuclear granulocytes, plasma cells, and mast cells, indicating that the disease is an infectious source disease. In the 1990s, with the application of PCR technology in biopsy tissues and peripheral blood, it provided new evidence for its infectious etiology. However, the infection, dissemination form, and whether it is related to other diseases of Tropheryma whippelii remain unclear to this day..

　　In the 1970s, some scholars confirmed that there is an immune deficiency in T lymphocytes and macrophages in patients with Whipple's disease. In recent years, some scholars have found that interleukin-12 and gamma interferon levels in patients with Whipple's disease have decreased. Mahnel et al. achieved good efficacy by using gamma interferon to assist in the treatment of refractory Whipple's disease, indicating that cell immunity plays a certain role in the pathogenesis of Whipple's disease.

　　Whipple's disease is caused by bacterial infection, often accompanied by diarrhea and severe malabsorption and other complications, and can also present with symptoms of heart, liver, and neurological diseases.Diarrhea is a common symptom, referring to the frequency of defecation significantly exceeding the usual frequency, with thin stools and increased water content, with daily defecation volume exceeding 200g, or containing undigested food or pus and mucus. Diarrhea is often accompanied by symptoms such as urgent defecation, anal discomfort, and incontinence. Diarrhea is divided into acute and chronic types..

　　Malabsorption syndrome is a syndrome caused by the obstruction of nutrient absorption in the small intestine, which is clinically divided into primary and secondary types. Primary malabsorption syndrome is caused by certain defects in the small intestinal mucosa, affecting the absorption of substances and the reesterification of fatty acids within the cells. Secondary malabsorption syndrome is seen in various factors causing dyspepsia or malabsorption, mainly due to the lack of bile salts and pancreatic digestive enzymes caused by liver, gallbladder, and pancreatic diseases. After partial gastrectomy, short bowel syndrome, changes in the pH value of the gastrointestinal tract, and diseases of the small intestine or mesentery can all affect the absorption and digestive functions of the small intestine. Malabsorption and digestive dysfunction caused by systemic diseases and some immune deficiencies include celiac disease and tropical sprue.

　　The most common symptoms of Whipple's disease are long-term, recurrent, and polyarticular arthritis or joint pain. Before the onset of arthritis, some patients may have diarrhea, which gradually progresses to steatorrhea. There are typical symptoms of malabsorption of the small intestine, and some cases may not have diarrhea, only abdominal pain and low fever. There are also systemic lymphadenopathy, and a few patients have splenomegaly.

　　Whipple's disease is caused by bacterial infection, and the pathogen enters through the mouth, so attention to dietary hygiene is the fundamental measure for preventing the disease. Secondly, it is necessary to strengthen physical exercise and improve the body's immunity.During the period of taking antibiotics, you can drink a cup of yogurt every day. The bifidobacteria contained in yogurt can not only alleviate the side effects of antibiotics but also promote digestion. After taking antibiotics, you should not eat fruit, especially sour fruits, as they can greatly reduce the efficacy of the medicine, delay treatment, and cause serious consequences..

　　Whipple's disease is a systemic disease, and the following examinations should be performed: erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), rheumatism laboratory examination items, blood routine, X-ray films of bones and joints in the limbs.The diagnosis can be established if lymph node biopsy or intestinal mucosal biopsy shows foamy macrophages containing glycoprotein (which can be stained by PAS), and bacterial culture can also be performed. The jejunum tissue may be normal or show villous bundles integrated into rods, and lymphatic vessels may dilate or part of the villi may atrophy. Electron microscopy examination shows that the PAS-positive substance is a pile of rod-shaped bacteria..

　　Patients with Whipple's disease should eat foods high in unsaturated fatty acids, low in saturated fatty acids, and warm in nature, and avoid eating foods high in calcium, high in cholesterol, and cold in nature. Patients taking antibiotics can eat more foods rich in vitamin B group, such as soybeans, lean meat, green leafy vegetables, etc., to alleviate the adverse reactions caused by taking medication.Most fruits (such as apples, apricots, cherries, grapes, oranges, tangerines, kiwis, etc.) contain a large amount of citric acid, malic acid, tartaric acid, and other sour components, which have a greater impact on the efficacy of antibiotics. It is best not to eat fruits or drink fruit juice within 2 hours after taking oral antibiotics..

　　In the past, Whipple's disease was considered incurable. In recent years, due to the research on the etiology of the disease and the use of antibiotic treatment, patients can be cured and recover health.Treatment mainly involves antibiotic therapy in addition to general symptomatic treatment. Procaine penicillin G 1.2 million units and streptomycin 1.0g are injected intramuscularly once a day for a total of 10 to 14 days, and then tetracycline 0.5g is taken orally 4 times a day to maintain for several months. Short treatment course is prone to recurrence, and the patient's symptoms improve and weight increases after the treatment starts. However, it may take several months to several years for the symptoms to completely disappear, and the histological recovery is even slower. Other antibiotics such as chloramphenicol, ampicillin, doxycycline, and SMZ (sulfamethoxazole) can also be used..