WHIPPLE’S DISEASE

By: Nikki T. Sia

From the house of BLACK
Infection

Auto-immunity
Impaired
Macrophages

Reduced B and T-cell

numbers

Trophyerma 1

Whipplei
2 Decreased CD11b

Prevents maturation of
phagosomes Defect in IL12
production

Low type 1 helper T cells (Th1)

in periphery and lamina
propria and reduced/absent T Decrease Th1 differentiation and IFN- -
whipplei-specific Th1 in mediated microbicidal competence of
periphery and mucosa macrophages

diminished IFN- production and defective

macrophage activation

Peripheral blood mononuclear cells; increased

production of IL-4

SEQUEL I
1
http://images.the-scientist.com/supplements/20070501/images/37-1.gif
2
http://emedicine.medscape.com/article/183350-overview
 WHIPPLE’S DISEASE
By: Nikki T. Sia
From the house of BLACK

SEQUEL I SEQUEL II

Functional Th2 in contrast increases

peripheral and mucosal
lymphocytes

Decrease in classically activating cytokines

and increase in alternatively activating IL-4

Increased susceptibility to T.
Whipplei infection

T whipplei replicates in
macrophages deactivated
by IL-4 & IL-10

3 4

Loss of microvilli at small intestinal

mucosa

Diagnostic tool: Intestinal biopsy

Infiltration of large foamy macrophages
with PAS-positive material SEQUEL III
Confirmatory Tool: PCR Based Assay

SEQUEL 2

3
http://cvi.asm.org/cgi/content/full/13/2/170
4
http://emedicine.medscape.com/article/183350-overview
 WHIPPLE’S DISEASE
By: Nikki T. Sia
From the house of BLACK

SEQUEL III

Small Intestines Due to malabsorption Lymph nodes Heart Joints

Joints CNS
CNS
6 7

Cachexia SEQUEL VI
DIARRHEA characterized LYMPHADENOPATHY ENDOCARDITIS SEQUEL VII
by STEATORRHEA
Distended abdomen

mediastinal Endocardial
angular cheilitis lymphadenopathy Lesion
WEIGHT LOSS

CALCIUM: Chvostek’s or
Trousseau sign Infection
Bronchial /tracheal
obstruction
VIT. C Deficiency:
Gingivitis and parafollicular platelets,fibrin,blood cells
hemorrhages & microoranisms form
Esophageal cluster of vegetations in
compression the endocardium
VIT. A Deficiency: Night
blindedness

erosion of node into a

Infection erodes unto the
bronchus or trachea
underlying heart tissues
Visible peristalsis with
borborygmi
Severe hypoxia
valvular deformities
Hyperpigmentation around the
orbital and malar areas of the face
SEQUEL VIII
5
SEQUEL IV
http://en.wikipedia.org/wiki/Whipple%27s_disease
 WHIPPLE’S DISEASE
By: Nikki T. Sia
From the house of BLACK

SEQUEL IV SEQUEL V

8
aortic stenosis
pulmonary congestion

aortic regurgitation increased Right

ventricular workload
increased blood volume &
pressure on L ventricle

Right ventricular strain

left ventricular
hypertrophy
Right ventricular failure

increased blood volume &

pressure on L atrium
Heart Failure

Left atrium hypertrophies

increased blood volume &

pressure on pulmonary veins

SEQUEL VIII

SEQUEL V

6
http://www.iill.net/whipple-s-disease
7
Brunner And Suddarth's Textbook Of Medical- Surgical Nursing, 11th Edition
8
Brunner And Suddarth's Textbook Of Medical- Surgical Nursing, 11th Edition
 WHIPPLE’S DISEASE
By: Nikki T. Sia
From the house of BLACK

SEQUEL VI SEQUEL VII

Frontal lobe: DEMENTIA

ARTHRITIS

Immobilization Cerebellum: ATAXIA

AND CLONUS

formation of contractures due to

9 prolonged immobilization
MENINGOENCEPHALITIS

Soft Tissue Deformity

Cerebral edema

Increased Intracranial pressure

decreased cerebral
perfusion/ischemia

infarction

necrosis

SEQUEL VIII
9
Brunner And Suddarth's Textbook Of Medical- Surgical Nursing, 11th Edition
 WHIPPLE’S DISEASE
By: Nikki T. Sia
From the house of BLACK

SEQUEL VIII

10

DEATH

10
http://emedicine.medscape.com/article/1166639-overview