CNS Whipple Disease Follow-up

Updated: Dec 10, 2019
  • Author: George C Bobustuc, MD; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Follow-up

Further Outpatient Care

Regular visits in various specialty clinics targeting monitoring clinical response to treatment of significant symptoms and laboratory tests should be pursued.

Significant symptom inventory should be reviewed with the patient at each clinic visit.

Treatment adherence should be emphasized continuously.

Guidelines for response assessment should be reviewed consistently with other specialty teams involved in the care of the patient.

CSF PCR analysis should be used as the ultimate tool in monitoring response and treatment decision making.

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Further Inpatient Care

Diagnosis and treatment of patients with Whipple disease should be based on a multiteam approach, targeting early involvement of gastroenterology, neurology, ophthalmology, cardiology, and rheumatology specialists.

No patients in whom multiple target-organ routine inventory status has been pursued, unless indicated by symptomatology or clinical examination (except for CNS), have been reported.

Some have speculated that by the time the CNS involvement becomes clinically relevant in patients with Whipple disease, they also might have disseminated pulmonary, cardiovascular, hepatic, and/or ocular disease. Furthermore, the choice and duration of antibiotic treatment might be influenced by the presence of disease in these organs.

The role of routine echocardiogram and chest and abdomen imaging (CT scan or MRI) remains to be established; these should be pursued on an individual case basis and on the clinician's need to know for significant management decisions and prognostic evaluation.

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Inpatient and Outpatient Medications

A long course of antibiotics (more than 1 y) that has good BBB penetrance represents the key in successful treatment of patients with Whipple disease.

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Deterrence/Prevention

Limited information suggests that the WD bacillus is a saprobe.

A limited number of cases have been reported of patients diagnosed with WD several months after spending vacation time in lake regions.

In patients who might have a specific IL-12–gamma-interferon axis defect, swimming in lakes may be hazardous, especially in those where accidental drainage of sewage water took place.

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