Whipple Disease Treatment & Management

Updated: Oct 24, 2019
  • Author: Ingram M Roberts, MD, MBA; Chief Editor: Burt Cagir, MD, FACS  more...
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Treatment

Approach Considerations

The mainstay of medical treatment for management of Whipple disease is antibiotic therapy. Surgery is not part of the therapy for Whipple disease. Once the diagnosis of Whipple disease is established and antibiotics are started, patients may be discharged for continued therapy as outpatients.

Consultations with a gastroenterologist, cardiologist, rheumatologist, orthopedist, and neurosurgeon (who will ask for a small biopsy, especially when there are no GI symptoms) may be necessary for obtaining the appropriate tissue biopsy in selected patients.

Outpatient monitoring

Patients with clinical Whipple disease should be monitored with a polmerase chain reaction (PCR), because it is the most sensitive and specific (in contrast to histology) method to determine if they are responding to antibiotic therapy.

T whipplei has been detected through PCR in normal saliva, gastric juice, and intestinal tissue. Whether its presence in otherwise healthy patients reflects a pathological state is unclear. Host factors may be important (as in the case of other GI conditions, such as H pylori infection) in determining which patients will actually develop clinical manifestations.

Balducci et al describe a case of a 76-year old woman presenting with rhombencephalitis who was receiving immunosuppressive treatment for rheumatoid arthritis. Leukocytes were slightly elevated; C-reactive protein and brain angio-CT scan were normal. The patient experienced rapid consciousness deterioration with cranial nerve deficits and ataxic paresis of the right upper limb. Brain MRI was performed, showing multiple contrast-enhancing lesions involving the pons, medulla and cerebellum, suggestive for rhombencephalitis. The patient improved on wide-spectrum antibiotic therapy. CSF analysis performed after 4 weeks of antibiotic therapy was positive for T whipplei. The patient experienced complete resolution of ocular and cranial nerve disorders; a 12-month follow-up lumbar puncture revealed normal CSF with negative T. whipplei-PCR. Follow-up is ongoing in order to monitor for possible relapses. [40]