Materiały źródłowe

• #1 Whipple’s disease – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/whipples-disease/symptoms-causes/syc-20378946

  Whipple disease is potentially life-threatening yet usually treatable. […] Without proper treatment, Whipple disease can be serious or fatal. However, a course of antibiotics can treat Whipple disease. […] Even after the infection is diagnosed and you’re receiving treatment, let your doctor know if your symptoms don’t improve. Sometimes antibiotic therapy isn’t effective because the bacteria are resistant to the particular drug you’re taking. The disease can recur, so it’s important to watch for symptoms that reappear.

• #2 Whipple’s disease – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/whipples-disease/diagnosis-treatment/drc-20378950

  Treatment of Whipple disease is with antibiotics, either alone or in combination, which can destroy the bacteria causing the infection. […] Treatment is long-term, generally lasting a year or two, with the aim of destroying the bacteria. But symptom relief generally comes much quicker, often within the first week or two. Most people with no brain or nervous system complications recover completely after a full course of antibiotics. […] When choosing antibiotics, doctors often select those that wipe out infections in the small intestine and also cross a layer of tissue around your brain (the blood-brain barrier). This is done to eliminate bacteria that may have entered your brain and central nervous system. […] In most cases, Whipple disease therapy begins with two to four weeks of ceftriaxone or penicillin given through a vein in your arm. Following that initial therapy, you’ll likely take an oral course of sulfamethoxazole-trimethoprim (Bactrim, Septra) for one to two years.

• #3 Whipple Disease | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/31348

  The mainstay of treatment for Whipple disease is antibiotic therapy. Because of the possibility of CNS involvement, even in the absence of symptoms, the use of antibiotics that penetrate the blood-brain barrier is desirable. One recommended regimen for the initial phase is Ceftriaxone two grams daily or Penicillin G two million units every four hours. The usual duration for the initial phase is two weeks, followed by the maintenance phase with Trimethoprim 160 mg- Sulfamethoxazole 800 mg twice daily for twelve months. Meropenem can also be used for the initial phase in patients with penicillin allergy. Long courses are usually necessary to prevent relapse. Unfortunately, relapse can occur even years after treatment. Often, CNS symptoms may be the first sign of relapse.[7][8] […] It is important to note that after the initial parenteral treatment, at least 12 months of treatment is required with oral trimethoprim-sulfamethoxazole. […] Body fluids must be evaluated for the organism to ensure a complete cure, which can take 1 to 2 years.

• #4 Whipple Disease | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/31348

  The mainstay of treatment for Whipple disease is antibiotic therapy. Because of the possibility of CNS involvement, even in the absence of symptoms, the use of antibiotics that penetrate the blood-brain barrier is desirable. One recommended regimen for the initial phase is Ceftriaxone two grams daily or Penicillin G two million units every four hours. The usual duration for the initial phase is two weeks, followed by the maintenance phase with Trimethoprim 160 mg- Sulfamethoxazole 800 mg twice daily for twelve months. Meropenem can also be used for the initial phase in patients with penicillin allergy. Long courses are usually necessary to prevent relapse. Unfortunately, relapse can occur even years after treatment. Often, CNS symptoms may be the first sign of relapse.[7][8] […] It is important to note that after the initial parenteral treatment, at least 12 months of treatment is required with oral trimethoprim-sulfamethoxazole. […] Body fluids must be evaluated for the organism to ensure a complete cure, which can take 1 to 2 years.

• #5 Whipple Disease Medication: Antibiotics

  https://emedicine.medscape.com/article/183350-medication

  The goals of pharmacotherapy are to reduce morbidity, to prevent complications, and to eradicate the infection. […] The standard initial treatment regimen is either (1) intravenous (IV) ceftriaxone 2 g once daily OR (2) 2 million units of penicillin G IV every 4 hours, both for 14 days’ duration. After the initial treatment is completed, 1 year of maintenance therapy is with oral double-strength trimethoprim-sulfamethoxazole twice daily. […] True relapse (as documented by positive PCR testing) may respond to 2 g ceftriaxone IV twice daily OR 4 million U penicillin G IV every 4 hours, both for 4 weeks’ duration, followed by 1 year of oral double strength trimethoprim-sulfamethoxazole twice daily. […] Antibiotics are the mainstay of treatment. Because of the tendency of Whipple disease to relapse on short courses of antibiotics (2 wk to several mo), most authorities suggest a prolonged course (as long as 1 y).

• #6 Whipple Disease | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/31348

  The mainstay of treatment for Whipple disease is antibiotic therapy. Because of the possibility of CNS involvement, even in the absence of symptoms, the use of antibiotics that penetrate the blood-brain barrier is desirable. One recommended regimen for the initial phase is Ceftriaxone two grams daily or Penicillin G two million units every four hours. The usual duration for the initial phase is two weeks, followed by the maintenance phase with Trimethoprim 160 mg- Sulfamethoxazole 800 mg twice daily for twelve months. Meropenem can also be used for the initial phase in patients with penicillin allergy. Long courses are usually necessary to prevent relapse. Unfortunately, relapse can occur even years after treatment. Often, CNS symptoms may be the first sign of relapse.[7][8] […] It is important to note that after the initial parenteral treatment, at least 12 months of treatment is required with oral trimethoprim-sulfamethoxazole. […] Body fluids must be evaluated for the organism to ensure a complete cure, which can take 1 to 2 years.

• #7 Whipple’s disease: the great masquerader—a high level of suspicion is the key to diagnosis | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-01664-1

  The patient was treated with ceftriaxone 2 g intravenously (IV) daily for two weeks with marked improvement already after three days. The patient was treated with ceftriaxone 2 g IV once a day for 14 days followed by TMP-SMX 800/160 mg twice a day. The patient was treated for 2 weeks with ceftriaxone (2 g IV once a day) followed by TMP-SMX 160 mg/800 mg, twice a day, planned for 1 year. WD has a dismal prognosis if left untreated. It is important to treat with antibiotics that penetrate the blood-brain barrier given that T. whipplei often is present in the CSF. WD without CNS involvement is initially treated with intravenous ceftriaxone 2 g once daily or meropenem (three doses of 1 g/day) for 2 weeks, followed by maintenance therapy with oral TMP-SMX 160 mg/800 mg twice a day for 1 year. The treatment for WD with endocarditis is penicillin G (2 million IU IV every 4 h) or ceftriaxone (2 g IV once daily) for 4 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. CNS involvement is treated with ceftriaxone (2 g IV once daily) or penicillin G (4 million IU IV every 4 h) for 2 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. Alternative therapies in case of intolerance are meropenem (1 g IV every 8 h) for 2 weeks followed by doxycycline (200 mg a day) in combination with hydroxychloroquine (600 mg a day) for 1 year. PCR for T. whipplei becomes negative soon after antibiotic therapy has commenced. Before stopping antibiotic therapy, upper endoscopy with duodenal biopsy and PCR testing is recommended to ensure complete remission. After discontinuation of antibiotic therapy, there is a 9-15% risk of T. whipplei to persist latently in the body for many years, mainly in patients with CNS involvement. The average interval between the end of antibiotic treatment and an ensuing relapse is 4.2 years but may occur even after 30 years. Therefore, annual check-ups are recommended for at least some years after the end of treatment.

• #8 Whipple’s disease – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/whipples-disease/diagnosis-treatment/drc-20378950

  Other medications that have been suggested as an alternative in some cases include oral doxycycline (Vibramycin, Doryx, others) combined with the antimalarial drug hydroxychloroquine (Plaquenil), which you’ll likely need to take for one to two years. […] Your symptoms should improve within one to two weeks of starting antibiotic treatment and go away entirely within about one month. […] Even after successful treatment, Whipple disease can recur. Doctors usually advise regular checkups. If you’ve experienced a recurrence, you’ll need to repeat antibiotic therapy. […] Because of the nutrient-absorption difficulties associated with Whipple disease, your doctor may recommend taking vitamin and mineral supplements to ensure adequate nutrition. Your body may require additional vitamin D, folic acid, calcium, iron and magnesium.

• #9 The Great Unknown, Whipple’s Disease | Reumatología Clínica

  https://www.reumatologiaclinica.org/en-the-great-unknown-whipple-s-disease-articulo-S2173574317300655

  Whipple’s disease was first described by George Hoyt Whipple in 1907. […] The patient was treated with cotrimoxazole for 2 years, accompanied by tetracycline for the first 3 months. […] Treatment was begun with ceftriaxone and imipenem, and included cefixime during the first 2 months. He was subsequently treated for 2 years with trimethoprim/sulfamethoxazole. […] The most widely accepted approach is the administration of intravenous ceftriaxone or another broad spectrum -lactam antibiotic for 2 weeks, followed by oral trimethoprim/sulfamethoxazole over a variable period of time, which is usually 1 year. A recent study recommends the combination of doxycycline and hydroxychloroquine for 1 year, and the maintenance of doxycycline for life, to avoid relapses that can occur with the preceding regimen.

• #10 Whipple’s disease: the great masquerader—a high level of suspicion is the key to diagnosis | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-01664-1

  The patient was treated with ceftriaxone 2 g intravenously (IV) daily for two weeks with marked improvement already after three days. The patient was treated with ceftriaxone 2 g IV once a day for 14 days followed by TMP-SMX 800/160 mg twice a day. The patient was treated for 2 weeks with ceftriaxone (2 g IV once a day) followed by TMP-SMX 160 mg/800 mg, twice a day, planned for 1 year. WD has a dismal prognosis if left untreated. It is important to treat with antibiotics that penetrate the blood-brain barrier given that T. whipplei often is present in the CSF. WD without CNS involvement is initially treated with intravenous ceftriaxone 2 g once daily or meropenem (three doses of 1 g/day) for 2 weeks, followed by maintenance therapy with oral TMP-SMX 160 mg/800 mg twice a day for 1 year. The treatment for WD with endocarditis is penicillin G (2 million IU IV every 4 h) or ceftriaxone (2 g IV once daily) for 4 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. CNS involvement is treated with ceftriaxone (2 g IV once daily) or penicillin G (4 million IU IV every 4 h) for 2 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. Alternative therapies in case of intolerance are meropenem (1 g IV every 8 h) for 2 weeks followed by doxycycline (200 mg a day) in combination with hydroxychloroquine (600 mg a day) for 1 year. PCR for T. whipplei becomes negative soon after antibiotic therapy has commenced. Before stopping antibiotic therapy, upper endoscopy with duodenal biopsy and PCR testing is recommended to ensure complete remission. After discontinuation of antibiotic therapy, there is a 9-15% risk of T. whipplei to persist latently in the body for many years, mainly in patients with CNS involvement. The average interval between the end of antibiotic treatment and an ensuing relapse is 4.2 years but may occur even after 30 years. Therefore, annual check-ups are recommended for at least some years after the end of treatment.

• #11 Whipple Disease Medication: Antibiotics

  https://emedicine.medscape.com/article/183350-medication

  The goals of pharmacotherapy are to reduce morbidity, to prevent complications, and to eradicate the infection. […] The standard initial treatment regimen is either (1) intravenous (IV) ceftriaxone 2 g once daily OR (2) 2 million units of penicillin G IV every 4 hours, both for 14 days’ duration. After the initial treatment is completed, 1 year of maintenance therapy is with oral double-strength trimethoprim-sulfamethoxazole twice daily. […] True relapse (as documented by positive PCR testing) may respond to 2 g ceftriaxone IV twice daily OR 4 million U penicillin G IV every 4 hours, both for 4 weeks’ duration, followed by 1 year of oral double strength trimethoprim-sulfamethoxazole twice daily. […] Antibiotics are the mainstay of treatment. Because of the tendency of Whipple disease to relapse on short courses of antibiotics (2 wk to several mo), most authorities suggest a prolonged course (as long as 1 y).

• #12 Whipple’s disease – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/whipples-disease/diagnosis-treatment/drc-20378950

  Treatment of Whipple disease is with antibiotics, either alone or in combination, which can destroy the bacteria causing the infection. […] Treatment is long-term, generally lasting a year or two, with the aim of destroying the bacteria. But symptom relief generally comes much quicker, often within the first week or two. Most people with no brain or nervous system complications recover completely after a full course of antibiotics. […] When choosing antibiotics, doctors often select those that wipe out infections in the small intestine and also cross a layer of tissue around your brain (the blood-brain barrier). This is done to eliminate bacteria that may have entered your brain and central nervous system. […] In most cases, Whipple disease therapy begins with two to four weeks of ceftriaxone or penicillin given through a vein in your arm. Following that initial therapy, you’ll likely take an oral course of sulfamethoxazole-trimethoprim (Bactrim, Septra) for one to two years.

• #13 Whipple Disease – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/malabsorption-syndromes/whipple-disease

  Treatment of Whipple disease is initiated with intravenous ceftriaxone or penicillin G for 2 to 4 weeks. This regimen is followed by a long-term course of oral therapy with trimethoprim/sulfamethoxazole or a combination of doxycycline and hydroxychloroquine. Sulfa-allergic patients may substitute oral penicillin VK or ampicillin. […] Many antibiotics are curative (eg, trimethoprim/sulfamethoxazole, penicillin, cephalosporins). […] To confirm response to treatment, polymerase chain reaction (PCR) testing can be performed on stool, saliva, or other tissue. However, other authorities recommend periodic follow-up biopsies with microscopy and PCR testing. […] Long-term antibiotic treatment is necessary, and relapses are common. […] Relapses are common and may occur years later. If relapse is suspected, small-bowel biopsies and/or PCR testing should be performed (regardless of affected organ systems) to determine presence of free bacilli.

• #14 Whipple’s disease – Wikipedia

  https://en.wikipedia.org/wiki/Whipple%27s_disease

  Whipple’s disease is significantly more common in men, with 87% of patients diagnosed being male. […] When recognized and treated, Whipple’s disease can usually be cured with long-term antibiotic therapy, but if the disease is left undiagnosed or untreated, it can ultimately be fatal. […] Treatment is with penicillin, ampicillin, tetracycline, or co-trimoxazole for one to two years. […] Expert opinion as of 2007 is that Whipple’s disease should be treated with doxycycline with hydroxychloroquine for 12 to 18 months. […] Hydroxychloroquine increases antibiotic and bactericides activity against the replication of the bacteria in acidic vacuoles of macrophages by increasing the macrophage intraphagosomal pH. […] Sulfonamides (sulfadiazine or sulfamethoxazole) may be added for treatment of neurological symptoms.

• #15

  https://link.springer.com/article/10.1007/BF02087770

  Whipple’s disease is a multisystemic disorder in which almost all organ systems can be invaded by rod-shaped bacteria. Without extended antimicrobial therapy, its course is lethal. Empirically, treatment consists of tetracyclines given for one to two years. […] Trimethoprim-sulfamethoxazole was also more efficacious than tetracycline in the treatment of cerebral Whipple’s disease. […] It is concluded that treatment with trimethoprim-sulfamethoxazole was significantly superior to that with tetracycline in inducing clinical remission of Whipple’s disease. A more active antimicrobial regimen is necessary to treat cerebral involvement.

• #16 What is the best therapy for Whipple’s disease? Our point of view – PubMed

  https://pubmed.ncbi.nlm.nih.gov/27924649/

  Although Whipple’s disease (WD) has been treated with antibiotics since the early 50s, the best antibiotics and the duration of the therapy have not yet been established. […] We consider here the pro and cons of the two most commonly used therapies, ceftriaxone followed by trimethoprim-sulfamethoxazole (TMP-SMZ) and hydroxychloroquine in combination with doxycycline. The therapy based on ceftriaxone and TMP-SMZ is efficient in the vast majority of patients for the first few years. However, since reinfections or reactivations can occur, a life-long prophylaxis is necessary and doxycycline is nowadays the best option. We thus propose a therapy based on merging these to therapies together, ceftriaxone, and TMP-SMZ for the first year(s) and then life-long prophylaxis with doxycycline.

• #17 Whipple’s disease – Wikipedia

  https://en.wikipedia.org/wiki/Whipple%27s_disease

  Whipple’s disease is significantly more common in men, with 87% of patients diagnosed being male. […] When recognized and treated, Whipple’s disease can usually be cured with long-term antibiotic therapy, but if the disease is left undiagnosed or untreated, it can ultimately be fatal. […] Treatment is with penicillin, ampicillin, tetracycline, or co-trimoxazole for one to two years. […] Expert opinion as of 2007 is that Whipple’s disease should be treated with doxycycline with hydroxychloroquine for 12 to 18 months. […] Hydroxychloroquine increases antibiotic and bactericides activity against the replication of the bacteria in acidic vacuoles of macrophages by increasing the macrophage intraphagosomal pH. […] Sulfonamides (sulfadiazine or sulfamethoxazole) may be added for treatment of neurological symptoms.

• #18 Whipple’s Disease: Symptoms, Diagnosis, Treatment & More

  https://www.healthline.com/health/whipples-disease

  An aggressive course of antibiotics is usually the first step in treatment, including 24 weeks of antibiotics through intravenous (IV) administration. In addition, you’ll likely be on daily antibiotics for 12 years. […] It’s not entirely clear which type of antibiotic is best for treating Whipple’s disease. Tetracycline had been a primary choice for a long time, but doctors found that many people would get the disease again and not respond well to secondary treatment. Penicillin or trimethoprim/sulfamethoxazole (TMP-SMX) achieved better results. […] Tell your doctor if you have an allergy to a particular antibiotic, as they have many other options they can try, including: amoxicillin, streptomycin, ampicillin, ceftriaxone, gentamicin, sulfonamide antibiotics, trimethoprim, erythromycin, neomycin, rifampin.

• #19 Whipple Disease Medication: Antibiotics

  https://emedicine.medscape.com/article/183350-medication

  The goals of pharmacotherapy are to reduce morbidity, to prevent complications, and to eradicate the infection. […] The standard initial treatment regimen is either (1) intravenous (IV) ceftriaxone 2 g once daily OR (2) 2 million units of penicillin G IV every 4 hours, both for 14 days’ duration. After the initial treatment is completed, 1 year of maintenance therapy is with oral double-strength trimethoprim-sulfamethoxazole twice daily. […] True relapse (as documented by positive PCR testing) may respond to 2 g ceftriaxone IV twice daily OR 4 million U penicillin G IV every 4 hours, both for 4 weeks’ duration, followed by 1 year of oral double strength trimethoprim-sulfamethoxazole twice daily. […] Antibiotics are the mainstay of treatment. Because of the tendency of Whipple disease to relapse on short courses of antibiotics (2 wk to several mo), most authorities suggest a prolonged course (as long as 1 y).

• #20 Whipple Disease | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/31348

  The mainstay of treatment for Whipple disease is antibiotic therapy. Because of the possibility of CNS involvement, even in the absence of symptoms, the use of antibiotics that penetrate the blood-brain barrier is desirable. One recommended regimen for the initial phase is Ceftriaxone two grams daily or Penicillin G two million units every four hours. The usual duration for the initial phase is two weeks, followed by the maintenance phase with Trimethoprim 160 mg- Sulfamethoxazole 800 mg twice daily for twelve months. Meropenem can also be used for the initial phase in patients with penicillin allergy. Long courses are usually necessary to prevent relapse. Unfortunately, relapse can occur even years after treatment. Often, CNS symptoms may be the first sign of relapse.[7][8] […] It is important to note that after the initial parenteral treatment, at least 12 months of treatment is required with oral trimethoprim-sulfamethoxazole. […] Body fluids must be evaluated for the organism to ensure a complete cure, which can take 1 to 2 years.

• #21 Whipple’s Disease: What Is It, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/5958-whipples-disease

  It can take a long time to get rid of the bacteria that cause Whipples disease. Treatment includes: […] Treatment typically involves receiving antibiotics by vein for two to four weeks. After that, you receive antibiotics that you take by mouth for at least the next 12 months. […] Your provider may recommend that you take supplements to make up for vitamins and nutrients your intestines cant absorb. […] If youre like most people with Whipples disease, youll feel better soon after you start treatment. But it can take as long as two years for your small intestine to recover completely. […] Treatment often cures Whipples disease, but it can come back after treatment. Your healthcare provider may recommend you have regular long-term follow-up tests. […] The most important thing is to take your antibiotics as prescribed. Most people will take antibiotics for at least a year after their diagnosis, and some people may need antibiotics for the rest of their lives.

• #22 What is the best therapy for Whipple’s disease? Our point of view – PubMed

  https://pubmed.ncbi.nlm.nih.gov/27924649/

  Although Whipple’s disease (WD) has been treated with antibiotics since the early 50s, the best antibiotics and the duration of the therapy have not yet been established. […] We consider here the pro and cons of the two most commonly used therapies, ceftriaxone followed by trimethoprim-sulfamethoxazole (TMP-SMZ) and hydroxychloroquine in combination with doxycycline. The therapy based on ceftriaxone and TMP-SMZ is efficient in the vast majority of patients for the first few years. However, since reinfections or reactivations can occur, a life-long prophylaxis is necessary and doxycycline is nowadays the best option. We thus propose a therapy based on merging these to therapies together, ceftriaxone, and TMP-SMZ for the first year(s) and then life-long prophylaxis with doxycycline.

• #23 The Great Unknown, Whipple’s Disease | Reumatología Clínica

  https://www.reumatologiaclinica.org/en-the-great-unknown-whipple-s-disease-articulo-S2173574317300655

  Whipple’s disease was first described by George Hoyt Whipple in 1907. […] The patient was treated with cotrimoxazole for 2 years, accompanied by tetracycline for the first 3 months. […] Treatment was begun with ceftriaxone and imipenem, and included cefixime during the first 2 months. He was subsequently treated for 2 years with trimethoprim/sulfamethoxazole. […] The most widely accepted approach is the administration of intravenous ceftriaxone or another broad spectrum -lactam antibiotic for 2 weeks, followed by oral trimethoprim/sulfamethoxazole over a variable period of time, which is usually 1 year. A recent study recommends the combination of doxycycline and hydroxychloroquine for 1 year, and the maintenance of doxycycline for life, to avoid relapses that can occur with the preceding regimen.

• #24 Whipple’s disease: the great masquerader—a high level of suspicion is the key to diagnosis | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-01664-1

  The patient was treated with ceftriaxone 2 g intravenously (IV) daily for two weeks with marked improvement already after three days. The patient was treated with ceftriaxone 2 g IV once a day for 14 days followed by TMP-SMX 800/160 mg twice a day. The patient was treated for 2 weeks with ceftriaxone (2 g IV once a day) followed by TMP-SMX 160 mg/800 mg, twice a day, planned for 1 year. WD has a dismal prognosis if left untreated. It is important to treat with antibiotics that penetrate the blood-brain barrier given that T. whipplei often is present in the CSF. WD without CNS involvement is initially treated with intravenous ceftriaxone 2 g once daily or meropenem (three doses of 1 g/day) for 2 weeks, followed by maintenance therapy with oral TMP-SMX 160 mg/800 mg twice a day for 1 year. The treatment for WD with endocarditis is penicillin G (2 million IU IV every 4 h) or ceftriaxone (2 g IV once daily) for 4 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. CNS involvement is treated with ceftriaxone (2 g IV once daily) or penicillin G (4 million IU IV every 4 h) for 2 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. Alternative therapies in case of intolerance are meropenem (1 g IV every 8 h) for 2 weeks followed by doxycycline (200 mg a day) in combination with hydroxychloroquine (600 mg a day) for 1 year. PCR for T. whipplei becomes negative soon after antibiotic therapy has commenced. Before stopping antibiotic therapy, upper endoscopy with duodenal biopsy and PCR testing is recommended to ensure complete remission. After discontinuation of antibiotic therapy, there is a 9-15% risk of T. whipplei to persist latently in the body for many years, mainly in patients with CNS involvement. The average interval between the end of antibiotic treatment and an ensuing relapse is 4.2 years but may occur even after 30 years. Therefore, annual check-ups are recommended for at least some years after the end of treatment.

• #25 Whipple Disease Treatment & Management: Approach Considerations

  https://emedicine.medscape.com/article/183350-treatment

  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. […] 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. […] 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.

• #26 Whipple Disease Treatment & Management: Approach Considerations

  https://emedicine.medscape.com/article/183350-treatment

  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. […] 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. […] 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.

• #27 Whipple Disease Treatment & Management: Approach Considerations

  https://emedicine.medscape.com/article/183350-treatment

  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. […] 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. […] 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.

• #28 Whipple Disease – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/malabsorption-syndromes/whipple-disease

  Treatment of Whipple disease is initiated with intravenous ceftriaxone or penicillin G for 2 to 4 weeks. This regimen is followed by a long-term course of oral therapy with trimethoprim/sulfamethoxazole or a combination of doxycycline and hydroxychloroquine. Sulfa-allergic patients may substitute oral penicillin VK or ampicillin. […] Many antibiotics are curative (eg, trimethoprim/sulfamethoxazole, penicillin, cephalosporins). […] To confirm response to treatment, polymerase chain reaction (PCR) testing can be performed on stool, saliva, or other tissue. However, other authorities recommend periodic follow-up biopsies with microscopy and PCR testing. […] Long-term antibiotic treatment is necessary, and relapses are common. […] Relapses are common and may occur years later. If relapse is suspected, small-bowel biopsies and/or PCR testing should be performed (regardless of affected organ systems) to determine presence of free bacilli.

• #29 Whipple Disease – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/malabsorption-syndromes/whipple-disease

  Treatment of Whipple disease is initiated with intravenous ceftriaxone or penicillin G for 2 to 4 weeks. This regimen is followed by a long-term course of oral therapy with trimethoprim/sulfamethoxazole or a combination of doxycycline and hydroxychloroquine. Sulfa-allergic patients may substitute oral penicillin VK or ampicillin. […] Many antibiotics are curative (eg, trimethoprim/sulfamethoxazole, penicillin, cephalosporins). […] To confirm response to treatment, polymerase chain reaction (PCR) testing can be performed on stool, saliva, or other tissue. However, other authorities recommend periodic follow-up biopsies with microscopy and PCR testing. […] Long-term antibiotic treatment is necessary, and relapses are common. […] Relapses are common and may occur years later. If relapse is suspected, small-bowel biopsies and/or PCR testing should be performed (regardless of affected organ systems) to determine presence of free bacilli.

• #30 Whipple Disease Treatment & Management: Approach Considerations

  https://emedicine.medscape.com/article/183350-treatment

  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. […] 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. […] 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.

• #31 Whipple’s disease: the great masquerader—a high level of suspicion is the key to diagnosis | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-01664-1

  The patient was treated with ceftriaxone 2 g intravenously (IV) daily for two weeks with marked improvement already after three days. The patient was treated with ceftriaxone 2 g IV once a day for 14 days followed by TMP-SMX 800/160 mg twice a day. The patient was treated for 2 weeks with ceftriaxone (2 g IV once a day) followed by TMP-SMX 160 mg/800 mg, twice a day, planned for 1 year. WD has a dismal prognosis if left untreated. It is important to treat with antibiotics that penetrate the blood-brain barrier given that T. whipplei often is present in the CSF. WD without CNS involvement is initially treated with intravenous ceftriaxone 2 g once daily or meropenem (three doses of 1 g/day) for 2 weeks, followed by maintenance therapy with oral TMP-SMX 160 mg/800 mg twice a day for 1 year. The treatment for WD with endocarditis is penicillin G (2 million IU IV every 4 h) or ceftriaxone (2 g IV once daily) for 4 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. CNS involvement is treated with ceftriaxone (2 g IV once daily) or penicillin G (4 million IU IV every 4 h) for 2 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. Alternative therapies in case of intolerance are meropenem (1 g IV every 8 h) for 2 weeks followed by doxycycline (200 mg a day) in combination with hydroxychloroquine (600 mg a day) for 1 year. PCR for T. whipplei becomes negative soon after antibiotic therapy has commenced. Before stopping antibiotic therapy, upper endoscopy with duodenal biopsy and PCR testing is recommended to ensure complete remission. After discontinuation of antibiotic therapy, there is a 9-15% risk of T. whipplei to persist latently in the body for many years, mainly in patients with CNS involvement. The average interval between the end of antibiotic treatment and an ensuing relapse is 4.2 years but may occur even after 30 years. Therefore, annual check-ups are recommended for at least some years after the end of treatment.

• #32 Whipple’s disease – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/whipples-disease/diagnosis-treatment/drc-20378950

  Treatment of Whipple disease is with antibiotics, either alone or in combination, which can destroy the bacteria causing the infection. […] Treatment is long-term, generally lasting a year or two, with the aim of destroying the bacteria. But symptom relief generally comes much quicker, often within the first week or two. Most people with no brain or nervous system complications recover completely after a full course of antibiotics. […] When choosing antibiotics, doctors often select those that wipe out infections in the small intestine and also cross a layer of tissue around your brain (the blood-brain barrier). This is done to eliminate bacteria that may have entered your brain and central nervous system. […] In most cases, Whipple disease therapy begins with two to four weeks of ceftriaxone or penicillin given through a vein in your arm. Following that initial therapy, you’ll likely take an oral course of sulfamethoxazole-trimethoprim (Bactrim, Septra) for one to two years.

• #33 Whipple’s disease – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/whipples-disease/diagnosis-treatment/drc-20378950

  Other medications that have been suggested as an alternative in some cases include oral doxycycline (Vibramycin, Doryx, others) combined with the antimalarial drug hydroxychloroquine (Plaquenil), which you’ll likely need to take for one to two years. […] Your symptoms should improve within one to two weeks of starting antibiotic treatment and go away entirely within about one month. […] Even after successful treatment, Whipple disease can recur. Doctors usually advise regular checkups. If you’ve experienced a recurrence, you’ll need to repeat antibiotic therapy. […] Because of the nutrient-absorption difficulties associated with Whipple disease, your doctor may recommend taking vitamin and mineral supplements to ensure adequate nutrition. Your body may require additional vitamin D, folic acid, calcium, iron and magnesium.

• #34 Whipple’s disease | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/whipples-disease?content_id=CON-20378931

  Your symptoms should improve within one to two weeks of starting antibiotic treatment and go away entirely within about one month. […] Even after successful treatment, Whipple disease can recur. Doctors usually advise regular checkups. If you’ve experienced a recurrence, you’ll need to repeat antibiotic therapy. […] Because of the nutrient-absorption difficulties associated with Whipple disease, your doctor may recommend taking vitamin and mineral supplements to ensure adequate nutrition. Your body may require additional vitamin D, folic acid, calcium, iron and magnesium.

• #35 Whipple disease: Symptoms, causes, and diagnosis

  https://www.medicalnewstoday.com/articles/188228

  Treatment with antibiotics is possible, but some patients relapse and need long-term treatment. […] Antibiotics now are the primary treatment for Whipple disease. They can prevent symptoms from being fatal. Therapy may include penicillin with or without other antibiotics such as streptomycin or erythromycin. […] Relapses are common. They can occur months or even years after initial treatment. They tend to affect the central nervous system, so any prescribed antibiotics need to have adequate blood-brain barrier penetration. […] With effective treatment, the mucus membrane around the small intestine, referred to as the mucosa, reverts to normal. Bacteria disappear within a few days, and after 1 to 2 months, only dying organisms may be seen. […] For a good outcome and successful management of symptoms, the following factors are also important: Proper fluid and electrolyte replacement is vital in patients with intestinal malabsorption. Iron or folate supplements can help correct anemia if it occurs. Vitamin D, calcium, and magnesium may be necessary to balance calcium levels. Vitamin K can correct coagulopathy, or the correct clotting of the blood. […] The patients diet should be appropriately high in calories, protein, and other vitamins as Whipple disease can lead to malnourishment. […] In rare cases, a long-term artificial supply of nutrients, also known as hyperalimentation, is necessary.

• #36 Whipple’s Disease: What Is It, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/5958-whipples-disease

  It can take a long time to get rid of the bacteria that cause Whipples disease. Treatment includes: […] Treatment typically involves receiving antibiotics by vein for two to four weeks. After that, you receive antibiotics that you take by mouth for at least the next 12 months. […] Your provider may recommend that you take supplements to make up for vitamins and nutrients your intestines cant absorb. […] If youre like most people with Whipples disease, youll feel better soon after you start treatment. But it can take as long as two years for your small intestine to recover completely. […] Treatment often cures Whipples disease, but it can come back after treatment. Your healthcare provider may recommend you have regular long-term follow-up tests. […] The most important thing is to take your antibiotics as prescribed. Most people will take antibiotics for at least a year after their diagnosis, and some people may need antibiotics for the rest of their lives.

• #37 Whipple’s Disease: Symptoms, Causes, Treatment, and More

  https://www.webmd.com/digestive-disorders/what-is-whipples-disease

  If tests show that you have Whipples disease, your doctor will give you antibiotics through an IV in your arm to kill the bacteria. […] They also may recommend fluids to keep you hydrated and extra vitamins and minerals to make sure you get enough nutrients. […] You should feel better in a couple of weeks, but it may take your small intestine up to 2 years to recover. During that time, you’ll continue to take antibiotics and supplements. […] If you have problems related to your nervous system, your doctor will use a combination of antibiotics, steroids, and other drugs, depending on your symptoms. […] Whipples disease can come back. You’ll need to see your doctor for regular checkups so you can treat it quickly if it does.

• #38 Whipple’s Disease: Symptoms, Diagnosis, Treatment & More

  https://www.healthline.com/health/whipples-disease

  Whipple’s disease can lead to death if it’s not treated properly. However, after treatment begins, many of the symptoms will go away within a month. […] Relapses are common. After you finish your course of antibiotics, you have a 9%-15% chance of the bacterium staying in your body, especially if you have nervous system symptoms. […] Still, the best thing you can do is continue taking your antibiotics and finish your course. Afterward, you may want to be monitored regularly by your doctor. If you experience a relapse, you’re more likely to experience new symptoms, especially neurological ones.

• #39 Whipple’s Disease: Symptoms and Causes | Doctor

  https://patient.info/doctor/whipples-disease

  Antibiotics are the main treatment. Expert microbiological advice will be needed. Prolonged treatment for 1-2 years is usually advised. […] Follow up closely for signs of recurrence – there is relapse in about 40%.

• #40 Whipple’s disease: the great masquerader—a high level of suspicion is the key to diagnosis | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-01664-1

  The patient was treated with ceftriaxone 2 g intravenously (IV) daily for two weeks with marked improvement already after three days. The patient was treated with ceftriaxone 2 g IV once a day for 14 days followed by TMP-SMX 800/160 mg twice a day. The patient was treated for 2 weeks with ceftriaxone (2 g IV once a day) followed by TMP-SMX 160 mg/800 mg, twice a day, planned for 1 year. WD has a dismal prognosis if left untreated. It is important to treat with antibiotics that penetrate the blood-brain barrier given that T. whipplei often is present in the CSF. WD without CNS involvement is initially treated with intravenous ceftriaxone 2 g once daily or meropenem (three doses of 1 g/day) for 2 weeks, followed by maintenance therapy with oral TMP-SMX 160 mg/800 mg twice a day for 1 year. The treatment for WD with endocarditis is penicillin G (2 million IU IV every 4 h) or ceftriaxone (2 g IV once daily) for 4 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. CNS involvement is treated with ceftriaxone (2 g IV once daily) or penicillin G (4 million IU IV every 4 h) for 2 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. Alternative therapies in case of intolerance are meropenem (1 g IV every 8 h) for 2 weeks followed by doxycycline (200 mg a day) in combination with hydroxychloroquine (600 mg a day) for 1 year. PCR for T. whipplei becomes negative soon after antibiotic therapy has commenced. Before stopping antibiotic therapy, upper endoscopy with duodenal biopsy and PCR testing is recommended to ensure complete remission. After discontinuation of antibiotic therapy, there is a 9-15% risk of T. whipplei to persist latently in the body for many years, mainly in patients with CNS involvement. The average interval between the end of antibiotic treatment and an ensuing relapse is 4.2 years but may occur even after 30 years. Therefore, annual check-ups are recommended for at least some years after the end of treatment.

• #41 Whipple’s disease: the great masquerader—a high level of suspicion is the key to diagnosis | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-01664-1

  The patient was treated with ceftriaxone 2 g intravenously (IV) daily for two weeks with marked improvement already after three days. The patient was treated with ceftriaxone 2 g IV once a day for 14 days followed by TMP-SMX 800/160 mg twice a day. The patient was treated for 2 weeks with ceftriaxone (2 g IV once a day) followed by TMP-SMX 160 mg/800 mg, twice a day, planned for 1 year. WD has a dismal prognosis if left untreated. It is important to treat with antibiotics that penetrate the blood-brain barrier given that T. whipplei often is present in the CSF. WD without CNS involvement is initially treated with intravenous ceftriaxone 2 g once daily or meropenem (three doses of 1 g/day) for 2 weeks, followed by maintenance therapy with oral TMP-SMX 160 mg/800 mg twice a day for 1 year. The treatment for WD with endocarditis is penicillin G (2 million IU IV every 4 h) or ceftriaxone (2 g IV once daily) for 4 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. CNS involvement is treated with ceftriaxone (2 g IV once daily) or penicillin G (4 million IU IV every 4 h) for 2 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. Alternative therapies in case of intolerance are meropenem (1 g IV every 8 h) for 2 weeks followed by doxycycline (200 mg a day) in combination with hydroxychloroquine (600 mg a day) for 1 year. PCR for T. whipplei becomes negative soon after antibiotic therapy has commenced. Before stopping antibiotic therapy, upper endoscopy with duodenal biopsy and PCR testing is recommended to ensure complete remission. After discontinuation of antibiotic therapy, there is a 9-15% risk of T. whipplei to persist latently in the body for many years, mainly in patients with CNS involvement. The average interval between the end of antibiotic treatment and an ensuing relapse is 4.2 years but may occur even after 30 years. Therefore, annual check-ups are recommended for at least some years after the end of treatment.

• #42 Whipple’s Disease: Symptoms, Diagnosis, Treatment & More

  https://www.healthline.com/health/whipples-disease

  Whipple’s disease can lead to death if it’s not treated properly. However, after treatment begins, many of the symptoms will go away within a month. […] Relapses are common. After you finish your course of antibiotics, you have a 9%-15% chance of the bacterium staying in your body, especially if you have nervous system symptoms. […] Still, the best thing you can do is continue taking your antibiotics and finish your course. Afterward, you may want to be monitored regularly by your doctor. If you experience a relapse, you’re more likely to experience new symptoms, especially neurological ones.

• #43 Whipple’s disease | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/whipples-disease?content_id=CON-20378931

  Your symptoms should improve within one to two weeks of starting antibiotic treatment and go away entirely within about one month. […] Even after successful treatment, Whipple disease can recur. Doctors usually advise regular checkups. If you’ve experienced a recurrence, you’ll need to repeat antibiotic therapy. […] Because of the nutrient-absorption difficulties associated with Whipple disease, your doctor may recommend taking vitamin and mineral supplements to ensure adequate nutrition. Your body may require additional vitamin D, folic acid, calcium, iron and magnesium.

• #44 Whipple’s disease: the great masquerader—a high level of suspicion is the key to diagnosis | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-01664-1

  The patient was treated with ceftriaxone 2 g intravenously (IV) daily for two weeks with marked improvement already after three days. The patient was treated with ceftriaxone 2 g IV once a day for 14 days followed by TMP-SMX 800/160 mg twice a day. The patient was treated for 2 weeks with ceftriaxone (2 g IV once a day) followed by TMP-SMX 160 mg/800 mg, twice a day, planned for 1 year. WD has a dismal prognosis if left untreated. It is important to treat with antibiotics that penetrate the blood-brain barrier given that T. whipplei often is present in the CSF. WD without CNS involvement is initially treated with intravenous ceftriaxone 2 g once daily or meropenem (three doses of 1 g/day) for 2 weeks, followed by maintenance therapy with oral TMP-SMX 160 mg/800 mg twice a day for 1 year. The treatment for WD with endocarditis is penicillin G (2 million IU IV every 4 h) or ceftriaxone (2 g IV once daily) for 4 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. CNS involvement is treated with ceftriaxone (2 g IV once daily) or penicillin G (4 million IU IV every 4 h) for 2 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. Alternative therapies in case of intolerance are meropenem (1 g IV every 8 h) for 2 weeks followed by doxycycline (200 mg a day) in combination with hydroxychloroquine (600 mg a day) for 1 year. PCR for T. whipplei becomes negative soon after antibiotic therapy has commenced. Before stopping antibiotic therapy, upper endoscopy with duodenal biopsy and PCR testing is recommended to ensure complete remission. After discontinuation of antibiotic therapy, there is a 9-15% risk of T. whipplei to persist latently in the body for many years, mainly in patients with CNS involvement. The average interval between the end of antibiotic treatment and an ensuing relapse is 4.2 years but may occur even after 30 years. Therefore, annual check-ups are recommended for at least some years after the end of treatment.

• #45 Whipple’s disease – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/whipples-disease/diagnosis-treatment/drc-20378950

  Other medications that have been suggested as an alternative in some cases include oral doxycycline (Vibramycin, Doryx, others) combined with the antimalarial drug hydroxychloroquine (Plaquenil), which you’ll likely need to take for one to two years. […] Your symptoms should improve within one to two weeks of starting antibiotic treatment and go away entirely within about one month. […] Even after successful treatment, Whipple disease can recur. Doctors usually advise regular checkups. If you’ve experienced a recurrence, you’ll need to repeat antibiotic therapy. […] Because of the nutrient-absorption difficulties associated with Whipple disease, your doctor may recommend taking vitamin and mineral supplements to ensure adequate nutrition. Your body may require additional vitamin D, folic acid, calcium, iron and magnesium.

• #46 Whipple’s disease – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/whipples-disease/diagnosis-treatment/drc-20378950

  Other medications that have been suggested as an alternative in some cases include oral doxycycline (Vibramycin, Doryx, others) combined with the antimalarial drug hydroxychloroquine (Plaquenil), which you’ll likely need to take for one to two years. […] Your symptoms should improve within one to two weeks of starting antibiotic treatment and go away entirely within about one month. […] Even after successful treatment, Whipple disease can recur. Doctors usually advise regular checkups. If you’ve experienced a recurrence, you’ll need to repeat antibiotic therapy. […] Because of the nutrient-absorption difficulties associated with Whipple disease, your doctor may recommend taking vitamin and mineral supplements to ensure adequate nutrition. Your body may require additional vitamin D, folic acid, calcium, iron and magnesium.

• #47 Whipple’s disease | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/whipples-disease?content_id=CON-20378931

  Your symptoms should improve within one to two weeks of starting antibiotic treatment and go away entirely within about one month. […] Even after successful treatment, Whipple disease can recur. Doctors usually advise regular checkups. If you’ve experienced a recurrence, you’ll need to repeat antibiotic therapy. […] Because of the nutrient-absorption difficulties associated with Whipple disease, your doctor may recommend taking vitamin and mineral supplements to ensure adequate nutrition. Your body may require additional vitamin D, folic acid, calcium, iron and magnesium.

• #48 Whipple’s disease | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/whipples-disease?content_id=CON-20378931

  Your symptoms should improve within one to two weeks of starting antibiotic treatment and go away entirely within about one month. […] Even after successful treatment, Whipple disease can recur. Doctors usually advise regular checkups. If you’ve experienced a recurrence, you’ll need to repeat antibiotic therapy. […] Because of the nutrient-absorption difficulties associated with Whipple disease, your doctor may recommend taking vitamin and mineral supplements to ensure adequate nutrition. Your body may require additional vitamin D, folic acid, calcium, iron and magnesium.

• #49 Whipple disease: Symptoms, causes, and diagnosis

  https://www.medicalnewstoday.com/articles/188228

  Treatment with antibiotics is possible, but some patients relapse and need long-term treatment. […] Antibiotics now are the primary treatment for Whipple disease. They can prevent symptoms from being fatal. Therapy may include penicillin with or without other antibiotics such as streptomycin or erythromycin. […] Relapses are common. They can occur months or even years after initial treatment. They tend to affect the central nervous system, so any prescribed antibiotics need to have adequate blood-brain barrier penetration. […] With effective treatment, the mucus membrane around the small intestine, referred to as the mucosa, reverts to normal. Bacteria disappear within a few days, and after 1 to 2 months, only dying organisms may be seen. […] For a good outcome and successful management of symptoms, the following factors are also important: Proper fluid and electrolyte replacement is vital in patients with intestinal malabsorption. Iron or folate supplements can help correct anemia if it occurs. Vitamin D, calcium, and magnesium may be necessary to balance calcium levels. Vitamin K can correct coagulopathy, or the correct clotting of the blood. […] The patients diet should be appropriately high in calories, protein, and other vitamins as Whipple disease can lead to malnourishment. […] In rare cases, a long-term artificial supply of nutrients, also known as hyperalimentation, is necessary.

• #50 Whipple disease: Symptoms, causes, and diagnosis

  https://www.medicalnewstoday.com/articles/188228

  Treatment with antibiotics is possible, but some patients relapse and need long-term treatment. […] Antibiotics now are the primary treatment for Whipple disease. They can prevent symptoms from being fatal. Therapy may include penicillin with or without other antibiotics such as streptomycin or erythromycin. […] Relapses are common. They can occur months or even years after initial treatment. They tend to affect the central nervous system, so any prescribed antibiotics need to have adequate blood-brain barrier penetration. […] With effective treatment, the mucus membrane around the small intestine, referred to as the mucosa, reverts to normal. Bacteria disappear within a few days, and after 1 to 2 months, only dying organisms may be seen. […] For a good outcome and successful management of symptoms, the following factors are also important: Proper fluid and electrolyte replacement is vital in patients with intestinal malabsorption. Iron or folate supplements can help correct anemia if it occurs. Vitamin D, calcium, and magnesium may be necessary to balance calcium levels. Vitamin K can correct coagulopathy, or the correct clotting of the blood. […] The patients diet should be appropriately high in calories, protein, and other vitamins as Whipple disease can lead to malnourishment. […] In rare cases, a long-term artificial supply of nutrients, also known as hyperalimentation, is necessary.

• #51 Whipple’s disease | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/whipples-disease?content_id=CON-20378931

  Your symptoms should improve within one to two weeks of starting antibiotic treatment and go away entirely within about one month. […] Even after successful treatment, Whipple disease can recur. Doctors usually advise regular checkups. If you’ve experienced a recurrence, you’ll need to repeat antibiotic therapy. […] Because of the nutrient-absorption difficulties associated with Whipple disease, your doctor may recommend taking vitamin and mineral supplements to ensure adequate nutrition. Your body may require additional vitamin D, folic acid, calcium, iron and magnesium.

• #52 Whipple disease: Symptoms, causes, and diagnosis

  https://www.medicalnewstoday.com/articles/188228

  Treatment with antibiotics is possible, but some patients relapse and need long-term treatment. […] Antibiotics now are the primary treatment for Whipple disease. They can prevent symptoms from being fatal. Therapy may include penicillin with or without other antibiotics such as streptomycin or erythromycin. […] Relapses are common. They can occur months or even years after initial treatment. They tend to affect the central nervous system, so any prescribed antibiotics need to have adequate blood-brain barrier penetration. […] With effective treatment, the mucus membrane around the small intestine, referred to as the mucosa, reverts to normal. Bacteria disappear within a few days, and after 1 to 2 months, only dying organisms may be seen. […] For a good outcome and successful management of symptoms, the following factors are also important: Proper fluid and electrolyte replacement is vital in patients with intestinal malabsorption. Iron or folate supplements can help correct anemia if it occurs. Vitamin D, calcium, and magnesium may be necessary to balance calcium levels. Vitamin K can correct coagulopathy, or the correct clotting of the blood. […] The patients diet should be appropriately high in calories, protein, and other vitamins as Whipple disease can lead to malnourishment. […] In rare cases, a long-term artificial supply of nutrients, also known as hyperalimentation, is necessary.

• #53 Whipple disease: Symptoms, causes, and diagnosis

  https://www.medicalnewstoday.com/articles/188228

  Treatment with antibiotics is possible, but some patients relapse and need long-term treatment. […] Antibiotics now are the primary treatment for Whipple disease. They can prevent symptoms from being fatal. Therapy may include penicillin with or without other antibiotics such as streptomycin or erythromycin. […] Relapses are common. They can occur months or even years after initial treatment. They tend to affect the central nervous system, so any prescribed antibiotics need to have adequate blood-brain barrier penetration. […] With effective treatment, the mucus membrane around the small intestine, referred to as the mucosa, reverts to normal. Bacteria disappear within a few days, and after 1 to 2 months, only dying organisms may be seen. […] For a good outcome and successful management of symptoms, the following factors are also important: Proper fluid and electrolyte replacement is vital in patients with intestinal malabsorption. Iron or folate supplements can help correct anemia if it occurs. Vitamin D, calcium, and magnesium may be necessary to balance calcium levels. Vitamin K can correct coagulopathy, or the correct clotting of the blood. […] The patients diet should be appropriately high in calories, protein, and other vitamins as Whipple disease can lead to malnourishment. […] In rare cases, a long-term artificial supply of nutrients, also known as hyperalimentation, is necessary.

• #54 UNDERSTANDING WHIPPLE’S DISEASE: TRANSMISSION, SYMPTOMS, AND TREATMENT OPTIONS | Mya Care

  https://myacare.com/blog/understanding-whipples-disease-transmission-symptoms-and-treatment-options

  The primary treatment for Whipple’s disease is long-term antibiotic therapy. The most commonly used antibiotic is Trimethoprim Sulfamethoxazole, taken for 1-2 years. In some cases, Ceftriaxone or doxycycline can treat recurrence or treatment-resistant cases. […] In addition to antibiotics, treatment for Whipple’s disease may also include fluid replacement to address malabsorption and vitamin and nutrient supplements to address any deficiencies. […] Individuals with Whipple’s disease may need to follow a specific diet to address malabsorption and nutrient deficiencies. An appropriate diet may include a high protein and calorie content and a low fat and fiber content. […] With proper treatment, most individuals with Whipple’s disease can make a full recovery. However, it is essential to continue taking antibiotics for the recommended duration to prevent a relapse. […] With early diagnosis and proper treatment, the prognosis for Whipple’s disease is generally reasonable. The patient starts to recover within 2-3 weeks. However, if left untreated, it could have serious consequences and can be fatal.

• #55 What Is Whipple Disease? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/whipples-disease/guide/

  With antibiotic treatment, Whipple disease can generally be cured. […] Treatment for Whipple disease typically involves taking antibiotics for a prolonged period of time at least one to two years to eradicate the bacteria thats causing the illness. […] Doctors may also recommend a diet thats high in calories and protein to make up for the malnutrition commonly experienced by people with Whipple disease. […] If you have Whipple disease, your doctor will first prescribe a two-week round of these types of IV antibiotics: ceftriaxone, meropenem (Merrem), penicillin G, streptomycin. […] After this initial treatment, you’ll have to take oral antibiotics for one to two years to make sure your body is clear of T. whipplei. […] Some individuals experience a relapse with worsening neurological symptoms, which may be treated with antibiotics and injections of interferon gamma, a protein that activates the immune system.

• #56 UNDERSTANDING WHIPPLE’S DISEASE: TRANSMISSION, SYMPTOMS, AND TREATMENT OPTIONS | Mya Care

  https://myacare.com/blog/understanding-whipples-disease-transmission-symptoms-and-treatment-options

  The primary treatment for Whipple’s disease is long-term antibiotic therapy. The most commonly used antibiotic is Trimethoprim Sulfamethoxazole, taken for 1-2 years. In some cases, Ceftriaxone or doxycycline can treat recurrence or treatment-resistant cases. […] In addition to antibiotics, treatment for Whipple’s disease may also include fluid replacement to address malabsorption and vitamin and nutrient supplements to address any deficiencies. […] Individuals with Whipple’s disease may need to follow a specific diet to address malabsorption and nutrient deficiencies. An appropriate diet may include a high protein and calorie content and a low fat and fiber content. […] With proper treatment, most individuals with Whipple’s disease can make a full recovery. However, it is essential to continue taking antibiotics for the recommended duration to prevent a relapse. […] With early diagnosis and proper treatment, the prognosis for Whipple’s disease is generally reasonable. The patient starts to recover within 2-3 weeks. However, if left untreated, it could have serious consequences and can be fatal.

• #57 Whipple’s Disease: Symptoms, Causes, Treatment, and More

  https://www.webmd.com/digestive-disorders/what-is-whipples-disease

  If tests show that you have Whipples disease, your doctor will give you antibiotics through an IV in your arm to kill the bacteria. […] They also may recommend fluids to keep you hydrated and extra vitamins and minerals to make sure you get enough nutrients. […] You should feel better in a couple of weeks, but it may take your small intestine up to 2 years to recover. During that time, you’ll continue to take antibiotics and supplements. […] If you have problems related to your nervous system, your doctor will use a combination of antibiotics, steroids, and other drugs, depending on your symptoms. […] Whipples disease can come back. You’ll need to see your doctor for regular checkups so you can treat it quickly if it does.

• #58

  https://step2.medbullets.com/gastrointestinal/120192/whipple-disease

  Treatment […] Whipple without cardiac involvement […] ceftriaxone or penicillin G for 2 weeks […] followed by TMP-SMX for one year […] […] […] Whipple with endocarditis […] ceftriaxone or PCN G for 4 weeks […] followed by TMP-SMX for one year […] […] […] Complications […] Jarisch-Herxheimer reaction to antibiotics […] fevers […] rigors […] hypotension […] […] […] Immune reconstitution inflammatory syndrome (IRIS) up to 10% […] high fever […] mimics worsening disease but is actually a result of successful therapy […] […] […] Prognosis […] Persistence after treatment common […] 30-50% rate of relapse […] Fatal if antibiotics not given

• #59

  https://step2.medbullets.com/gastrointestinal/120192/whipple-disease

  Treatment […] Whipple without cardiac involvement […] ceftriaxone or penicillin G for 2 weeks […] followed by TMP-SMX for one year […] […] […] Whipple with endocarditis […] ceftriaxone or PCN G for 4 weeks […] followed by TMP-SMX for one year […] […] […] Complications […] Jarisch-Herxheimer reaction to antibiotics […] fevers […] rigors […] hypotension […] […] […] Immune reconstitution inflammatory syndrome (IRIS) up to 10% […] high fever […] mimics worsening disease but is actually a result of successful therapy […] […] […] Prognosis […] Persistence after treatment common […] 30-50% rate of relapse […] Fatal if antibiotics not given

• #60 Connecting the Dots: The Many Systemic Manifestations of Whipple Disease – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/january-2012/connecting-the-dots-the-many-systemic-manifestations-of-whipple-disease/

  The patient was treated with intravenous ceftriaxone for 4 weeks followed by oral trimethoprim/sulfamethoxazole for 1 year. […] Treatment with steroids was started to decrease the risk of immune reconstitution inflammatory syndrome (IRIS). […] Treatment of Whipple disease consists of an initial 2-week course of intravenous ceftriaxone or meropenem or parenteral penicillin G and streptomycin, followed by a 1-year course of trimethoprim/sulfamethoxazole, which readily crosses the blood-brain barrier. […] Antibiotic therapy is usually highly effective, with rapid improvement in gastrointestinal and extraintestinal symptoms; however, relapses are fairly common. […] After 1 year of antibiotic therapy, a repeat small intestinal mucosal biopsy is recommended to document the absence of residual bacilli. […] A repeat endoscopy in the patient presented by Longman and colleagues revealed resolution of the endoscopic findings and near-complete disappearance of the PAS-positive macrophages.

• #61 Unusual effectiveness of systemic steroids in Whipple disease | Pulmonology

  https://www.journalpulmonology.org/en-unusual-effectiveness-systemic-steroids-in-articulo-S2531043720300337

  Whipples disease is a rare disorder caused by the Gram-positive bacterium Tropheryma whipplei (TW), formerly known as Tropheryma whippelii, that localizes initially in the lamina propria of small bowel with prominent gastrointestinal symptoms and weight loss. […] The decision to perform trans-bronchial biopsies of the lung parenchymal consolidations with rigid bronchoscope was thus taken with patient under sedation after intubation; histology is reported in Fig. 3. After the procedure, a steroid therapy with 1.5mg/kg of methylprednisolone was started and a rapid clinical improvement with a parallel resolution of the respiratory failure was observed over the following days. […] However, the case here reported was atypical: first, we did not find PCR positivity for TW in the biopsy (despite the PAS positivity); second, patient clinically improved once systemic steroid therapy was instituted, although steroids are not a cornerstone of disease treatment.

• #62 What Is Whipple Disease? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/whipples-disease/guide/

  With antibiotic treatment, Whipple disease can generally be cured. […] Treatment for Whipple disease typically involves taking antibiotics for a prolonged period of time at least one to two years to eradicate the bacteria thats causing the illness. […] Doctors may also recommend a diet thats high in calories and protein to make up for the malnutrition commonly experienced by people with Whipple disease. […] If you have Whipple disease, your doctor will first prescribe a two-week round of these types of IV antibiotics: ceftriaxone, meropenem (Merrem), penicillin G, streptomycin. […] After this initial treatment, you’ll have to take oral antibiotics for one to two years to make sure your body is clear of T. whipplei. […] Some individuals experience a relapse with worsening neurological symptoms, which may be treated with antibiotics and injections of interferon gamma, a protein that activates the immune system.

• #63

  https://link.springer.com/article/10.1007/s11882-001-0066-7

  Whipples disease is a rare, chronic, and systemic infectious disease caused by the ubiquitously occuring bacterium Tropheryma whippelii. […] These findings have led to an improved pathophysiologic understanding of the disease and to new aspects in treatment strategies that are discussed in this paper. […] An evaluation of antimicrobial treatment for Whipples disease: tetracycline versus trimethoprim-sulfamethoxazole. A large retrospective therapy study emphasizing the superior role of trimethoprim-sulfamethoxazole over tetracycline in the primary treatment of Whipples disease and the treatment of relapse. […] Treatment of refractory Whipples disease with recombinant interferon-gamma. […] Antibiotic treatment and relapse in Whipples disease.

• #64 Whipple’s disease: the great masquerader—a high level of suspicion is the key to diagnosis | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-01664-1

  The patient was treated with ceftriaxone 2 g intravenously (IV) daily for two weeks with marked improvement already after three days. The patient was treated with ceftriaxone 2 g IV once a day for 14 days followed by TMP-SMX 800/160 mg twice a day. The patient was treated for 2 weeks with ceftriaxone (2 g IV once a day) followed by TMP-SMX 160 mg/800 mg, twice a day, planned for 1 year. WD has a dismal prognosis if left untreated. It is important to treat with antibiotics that penetrate the blood-brain barrier given that T. whipplei often is present in the CSF. WD without CNS involvement is initially treated with intravenous ceftriaxone 2 g once daily or meropenem (three doses of 1 g/day) for 2 weeks, followed by maintenance therapy with oral TMP-SMX 160 mg/800 mg twice a day for 1 year. The treatment for WD with endocarditis is penicillin G (2 million IU IV every 4 h) or ceftriaxone (2 g IV once daily) for 4 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. CNS involvement is treated with ceftriaxone (2 g IV once daily) or penicillin G (4 million IU IV every 4 h) for 2 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. Alternative therapies in case of intolerance are meropenem (1 g IV every 8 h) for 2 weeks followed by doxycycline (200 mg a day) in combination with hydroxychloroquine (600 mg a day) for 1 year. PCR for T. whipplei becomes negative soon after antibiotic therapy has commenced. Before stopping antibiotic therapy, upper endoscopy with duodenal biopsy and PCR testing is recommended to ensure complete remission. After discontinuation of antibiotic therapy, there is a 9-15% risk of T. whipplei to persist latently in the body for many years, mainly in patients with CNS involvement. The average interval between the end of antibiotic treatment and an ensuing relapse is 4.2 years but may occur even after 30 years. Therefore, annual check-ups are recommended for at least some years after the end of treatment.

• #65 Whipple disease | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/whipple-disease?lang=us

  CNS involvement with Whipple disease carries a poor prognosis and is invariably fatal without treatment. Approximately half of the patients may show some symptomatic improvement during antibiotic treatment. ~17.5% (range 2-33%) patients may relapse. Thus, early diagnosis and treatment are paramount for survival 6.

• #66 Whipple’s disease: the great masquerader—a high level of suspicion is the key to diagnosis | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-01664-1

  The patient was treated with ceftriaxone 2 g intravenously (IV) daily for two weeks with marked improvement already after three days. The patient was treated with ceftriaxone 2 g IV once a day for 14 days followed by TMP-SMX 800/160 mg twice a day. The patient was treated for 2 weeks with ceftriaxone (2 g IV once a day) followed by TMP-SMX 160 mg/800 mg, twice a day, planned for 1 year. WD has a dismal prognosis if left untreated. It is important to treat with antibiotics that penetrate the blood-brain barrier given that T. whipplei often is present in the CSF. WD without CNS involvement is initially treated with intravenous ceftriaxone 2 g once daily or meropenem (three doses of 1 g/day) for 2 weeks, followed by maintenance therapy with oral TMP-SMX 160 mg/800 mg twice a day for 1 year. The treatment for WD with endocarditis is penicillin G (2 million IU IV every 4 h) or ceftriaxone (2 g IV once daily) for 4 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. CNS involvement is treated with ceftriaxone (2 g IV once daily) or penicillin G (4 million IU IV every 4 h) for 2 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. Alternative therapies in case of intolerance are meropenem (1 g IV every 8 h) for 2 weeks followed by doxycycline (200 mg a day) in combination with hydroxychloroquine (600 mg a day) for 1 year. PCR for T. whipplei becomes negative soon after antibiotic therapy has commenced. Before stopping antibiotic therapy, upper endoscopy with duodenal biopsy and PCR testing is recommended to ensure complete remission. After discontinuation of antibiotic therapy, there is a 9-15% risk of T. whipplei to persist latently in the body for many years, mainly in patients with CNS involvement. The average interval between the end of antibiotic treatment and an ensuing relapse is 4.2 years but may occur even after 30 years. Therefore, annual check-ups are recommended for at least some years after the end of treatment.

• #67 SciELO Brazil – Whipple’s disease: rare disorder and late diagnosis Whipple’s disease: rare disorder and late diagnosis

  https://www.scielo.br/j/rimtsp/a/M6VVJ4WyhLgvZRvRHSQYGwb/?lang=en

  Thus, the antibiotic selection was based on the fact that trimethoprim/sulfamethoxazole is an antibiotic that crosses the blood-brain barrier, with probability of being effective in the CNS involvement. […] Whipple’s disease is an infectious disease with an excellent clinical response within a few weeks after initiation of antibiotic therapy. […] According to different studies, the decision to discontinue therapy seems to depend on clinical and laboratory remission, as well as on decreased amount of PAS-positive macrophages and absence of free bacilli in follow-up biopsies after apparent clinical remission. […] In cases of failure or relapse, other antibiotic regimens are suggested. In patients without neurological involvement, doxycycline (100 mg twice a day) in combination with hydroxychloroquine (600 mg/day) without induction could be used. In patients with neurologic manifestations or positive CSF PCR, the regimen mentioned above may be associated with sulfadiazine.

• #68 Whipple Disease Treatment & Management: Approach Considerations

  https://emedicine.medscape.com/article/183350-treatment

  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. […] 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. […] 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.

• #69 Whipple disease | MedLink Neurology

  https://www.medlink.com/articles/whipple-disease

  Whipple disease is a treatable, multisystem disease caused by infection with Tropheryma whipplei. […] Antibiotic treatment results in improvement with a sustained remission in the majority of patients. […] Antibiotics can successfully treat Whipple disease of the brain and prevent fatal infection. […] Whipple disease of the brain can be fatal if untreated and neurologic symptomatology, especially eye movement disorder, may persist after MRI and even after molecular evidence of eradication of infection. […] A generally accepted regime is provided in Table 4. […] Retrospective analyses on small series of patients have suggested that co-trimoxazole (trimethoprim-sulfamethoxazole) is one of the best oral treatments. […] The European Network on T whipplei Infection completed the first prospective nonrandomized trial comparing parenteral meropenem (3 g daily) with ceftriaxone (2 g daily) for the first 2 weeks of therapy, followed by maintenance with oral trimethoprim-sulfamethoxazole for the first year, in 40 patients.

• #70 Whipple’s disease: the great masquerader—a high level of suspicion is the key to diagnosis | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-01664-1

  The patient was treated with ceftriaxone 2 g intravenously (IV) daily for two weeks with marked improvement already after three days. The patient was treated with ceftriaxone 2 g IV once a day for 14 days followed by TMP-SMX 800/160 mg twice a day. The patient was treated for 2 weeks with ceftriaxone (2 g IV once a day) followed by TMP-SMX 160 mg/800 mg, twice a day, planned for 1 year. WD has a dismal prognosis if left untreated. It is important to treat with antibiotics that penetrate the blood-brain barrier given that T. whipplei often is present in the CSF. WD without CNS involvement is initially treated with intravenous ceftriaxone 2 g once daily or meropenem (three doses of 1 g/day) for 2 weeks, followed by maintenance therapy with oral TMP-SMX 160 mg/800 mg twice a day for 1 year. The treatment for WD with endocarditis is penicillin G (2 million IU IV every 4 h) or ceftriaxone (2 g IV once daily) for 4 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. CNS involvement is treated with ceftriaxone (2 g IV once daily) or penicillin G (4 million IU IV every 4 h) for 2 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. Alternative therapies in case of intolerance are meropenem (1 g IV every 8 h) for 2 weeks followed by doxycycline (200 mg a day) in combination with hydroxychloroquine (600 mg a day) for 1 year. PCR for T. whipplei becomes negative soon after antibiotic therapy has commenced. Before stopping antibiotic therapy, upper endoscopy with duodenal biopsy and PCR testing is recommended to ensure complete remission. After discontinuation of antibiotic therapy, there is a 9-15% risk of T. whipplei to persist latently in the body for many years, mainly in patients with CNS involvement. The average interval between the end of antibiotic treatment and an ensuing relapse is 4.2 years but may occur even after 30 years. Therefore, annual check-ups are recommended for at least some years after the end of treatment.

• #71 Whipple’s disease: the great masquerader—a high level of suspicion is the key to diagnosis | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-01664-1

  The patient was treated with ceftriaxone 2 g intravenously (IV) daily for two weeks with marked improvement already after three days. The patient was treated with ceftriaxone 2 g IV once a day for 14 days followed by TMP-SMX 800/160 mg twice a day. The patient was treated for 2 weeks with ceftriaxone (2 g IV once a day) followed by TMP-SMX 160 mg/800 mg, twice a day, planned for 1 year. WD has a dismal prognosis if left untreated. It is important to treat with antibiotics that penetrate the blood-brain barrier given that T. whipplei often is present in the CSF. WD without CNS involvement is initially treated with intravenous ceftriaxone 2 g once daily or meropenem (three doses of 1 g/day) for 2 weeks, followed by maintenance therapy with oral TMP-SMX 160 mg/800 mg twice a day for 1 year. The treatment for WD with endocarditis is penicillin G (2 million IU IV every 4 h) or ceftriaxone (2 g IV once daily) for 4 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. CNS involvement is treated with ceftriaxone (2 g IV once daily) or penicillin G (4 million IU IV every 4 h) for 2 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. Alternative therapies in case of intolerance are meropenem (1 g IV every 8 h) for 2 weeks followed by doxycycline (200 mg a day) in combination with hydroxychloroquine (600 mg a day) for 1 year. PCR for T. whipplei becomes negative soon after antibiotic therapy has commenced. Before stopping antibiotic therapy, upper endoscopy with duodenal biopsy and PCR testing is recommended to ensure complete remission. After discontinuation of antibiotic therapy, there is a 9-15% risk of T. whipplei to persist latently in the body for many years, mainly in patients with CNS involvement. The average interval between the end of antibiotic treatment and an ensuing relapse is 4.2 years but may occur even after 30 years. Therefore, annual check-ups are recommended for at least some years after the end of treatment.

• #72 Whipple’s disease: the great masquerader—a high level of suspicion is the key to diagnosis | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-01664-1

  The patient was treated with ceftriaxone 2 g intravenously (IV) daily for two weeks with marked improvement already after three days. The patient was treated with ceftriaxone 2 g IV once a day for 14 days followed by TMP-SMX 800/160 mg twice a day. The patient was treated for 2 weeks with ceftriaxone (2 g IV once a day) followed by TMP-SMX 160 mg/800 mg, twice a day, planned for 1 year. WD has a dismal prognosis if left untreated. It is important to treat with antibiotics that penetrate the blood-brain barrier given that T. whipplei often is present in the CSF. WD without CNS involvement is initially treated with intravenous ceftriaxone 2 g once daily or meropenem (three doses of 1 g/day) for 2 weeks, followed by maintenance therapy with oral TMP-SMX 160 mg/800 mg twice a day for 1 year. The treatment for WD with endocarditis is penicillin G (2 million IU IV every 4 h) or ceftriaxone (2 g IV once daily) for 4 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. CNS involvement is treated with ceftriaxone (2 g IV once daily) or penicillin G (4 million IU IV every 4 h) for 2 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. Alternative therapies in case of intolerance are meropenem (1 g IV every 8 h) for 2 weeks followed by doxycycline (200 mg a day) in combination with hydroxychloroquine (600 mg a day) for 1 year. PCR for T. whipplei becomes negative soon after antibiotic therapy has commenced. Before stopping antibiotic therapy, upper endoscopy with duodenal biopsy and PCR testing is recommended to ensure complete remission. After discontinuation of antibiotic therapy, there is a 9-15% risk of T. whipplei to persist latently in the body for many years, mainly in patients with CNS involvement. The average interval between the end of antibiotic treatment and an ensuing relapse is 4.2 years but may occur even after 30 years. Therefore, annual check-ups are recommended for at least some years after the end of treatment.

• #73 Whipple’s disease diagnosed during anti-tumor necrosis factor alpha treatment: two case reports and review of the literature | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-015-0632-6

  Whipples disease should be suspected in all patients diagnosed with chronic inflammatory rheumatism, partially controlled or not controlled by treatment with tumor necrosis factor alpha blockers, whose condition worsens after treatment. […] Therapies with immunomodulators, TNF- inhibitors, and corticosteroids may transform an infection with T. whipplei, normally at a subacute stage, into a septic, life-threatening disease. Thus, it seems that TNF- blockade allowed for rapid dissemination of T. whipplei by inhibiting some important immune defense mechanisms. […] In summary, anti-TNF- treatment seems to increase the risk of exacerbation of WD and WD may mimic a rheumatic disease.

• #74 Whipple’s disease diagnosed during anti-tumor necrosis factor alpha treatment: two case reports and review of the literature | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-015-0632-6

  Whipples disease should be suspected in all patients diagnosed with chronic inflammatory rheumatism, partially controlled or not controlled by treatment with tumor necrosis factor alpha blockers, whose condition worsens after treatment. […] Therapies with immunomodulators, TNF- inhibitors, and corticosteroids may transform an infection with T. whipplei, normally at a subacute stage, into a septic, life-threatening disease. Thus, it seems that TNF- blockade allowed for rapid dissemination of T. whipplei by inhibiting some important immune defense mechanisms. […] In summary, anti-TNF- treatment seems to increase the risk of exacerbation of WD and WD may mimic a rheumatic disease.

• #75 Orphanet: Whipple disease

  https://www.orpha.net/en/disease/detail/3452

  According to the only available prospective randomized trial, treatment should consist in: 2 g Ceftriaxon daily intravenously for 14 days, followed by Cotrimoxazol twice daily for 12 months. […] In recurrent or resistant cerebral infection, contact with a TW specialist is recommended. Expert advice concerning treatment is indispensable in patients who have received immunosuppressive treatment prior to the diagnosis, including oral steroids, or when a clinical response to Ceftriaxone is not apparent within a few days. […] Lifelong clinical, non-invasive observation is advised in effectively treated patients, as late recurrences or de novo infections can occur.

• #76 What is the best therapy for Whipple’s disease? Our point of view – PubMed

  https://pubmed.ncbi.nlm.nih.gov/27924649/

  Although Whipple’s disease (WD) has been treated with antibiotics since the early 50s, the best antibiotics and the duration of the therapy have not yet been established. […] We consider here the pro and cons of the two most commonly used therapies, ceftriaxone followed by trimethoprim-sulfamethoxazole (TMP-SMZ) and hydroxychloroquine in combination with doxycycline. The therapy based on ceftriaxone and TMP-SMZ is efficient in the vast majority of patients for the first few years. However, since reinfections or reactivations can occur, a life-long prophylaxis is necessary and doxycycline is nowadays the best option. We thus propose a therapy based on merging these to therapies together, ceftriaxone, and TMP-SMZ for the first year(s) and then life-long prophylaxis with doxycycline.

• #77 Whipple’s disease: Charité – Universitätsmedizin Berlin

  https://www.charite.de/en/research/paper_spotlight/new_findings_on_the_treatment_of_whipples_disease

  Researchers from Charit Universittsmedizin Berlin have gained new insights into the treatment of Whipple’s disease, a rare infectious disease that has a very poor prognosis without antibiotic treatment. […] However, the combination of intravenous infusions with ceftriaxone for 14 days in hospital, followed by 12 months of trimethoprim/sulfamethoxazole (cotrimoxazole) tablets is effective and is currently recommended in Germany. […] The comparison showed that oral-only therapy is just as suitable for treating Whipple’s disease as intravenous-oral therapy. […] Oral-only therapy for Whipple’s disease is just as effective as intravenous-oral combination therapy and is safe to use.

• #78 What is the best therapy for Whipple’s disease? Our point of view – PubMed

  https://pubmed.ncbi.nlm.nih.gov/27924649/

  Although Whipple’s disease (WD) has been treated with antibiotics since the early 50s, the best antibiotics and the duration of the therapy have not yet been established. […] We consider here the pro and cons of the two most commonly used therapies, ceftriaxone followed by trimethoprim-sulfamethoxazole (TMP-SMZ) and hydroxychloroquine in combination with doxycycline. The therapy based on ceftriaxone and TMP-SMZ is efficient in the vast majority of patients for the first few years. However, since reinfections or reactivations can occur, a life-long prophylaxis is necessary and doxycycline is nowadays the best option. We thus propose a therapy based on merging these to therapies together, ceftriaxone, and TMP-SMZ for the first year(s) and then life-long prophylaxis with doxycycline.

• #79 Whipple’s disease: Charité – Universitätsmedizin Berlin

  https://www.charite.de/en/research/paper_spotlight/new_findings_on_the_treatment_of_whipples_disease

  Researchers from Charit Universittsmedizin Berlin have gained new insights into the treatment of Whipple’s disease, a rare infectious disease that has a very poor prognosis without antibiotic treatment. […] However, the combination of intravenous infusions with ceftriaxone for 14 days in hospital, followed by 12 months of trimethoprim/sulfamethoxazole (cotrimoxazole) tablets is effective and is currently recommended in Germany. […] The comparison showed that oral-only therapy is just as suitable for treating Whipple’s disease as intravenous-oral therapy. […] Oral-only therapy for Whipple’s disease is just as effective as intravenous-oral combination therapy and is safe to use.

• #80 What is the best therapy for Whipple’s disease? Our point of view – PubMed

  https://pubmed.ncbi.nlm.nih.gov/27924649/

  Although Whipple’s disease (WD) has been treated with antibiotics since the early 50s, the best antibiotics and the duration of the therapy have not yet been established. […] We consider here the pro and cons of the two most commonly used therapies, ceftriaxone followed by trimethoprim-sulfamethoxazole (TMP-SMZ) and hydroxychloroquine in combination with doxycycline. The therapy based on ceftriaxone and TMP-SMZ is efficient in the vast majority of patients for the first few years. However, since reinfections or reactivations can occur, a life-long prophylaxis is necessary and doxycycline is nowadays the best option. We thus propose a therapy based on merging these to therapies together, ceftriaxone, and TMP-SMZ for the first year(s) and then life-long prophylaxis with doxycycline.

• #81

  https://link.springer.com/article/10.1007/s11882-001-0066-7

  Whipples disease is a rare, chronic, and systemic infectious disease caused by the ubiquitously occuring bacterium Tropheryma whippelii. […] These findings have led to an improved pathophysiologic understanding of the disease and to new aspects in treatment strategies that are discussed in this paper. […] An evaluation of antimicrobial treatment for Whipples disease: tetracycline versus trimethoprim-sulfamethoxazole. A large retrospective therapy study emphasizing the superior role of trimethoprim-sulfamethoxazole over tetracycline in the primary treatment of Whipples disease and the treatment of relapse. […] Treatment of refractory Whipples disease with recombinant interferon-gamma. […] Antibiotic treatment and relapse in Whipples disease.

• #82 Whipple’s disease: the great masquerader—a high level of suspicion is the key to diagnosis | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-01664-1

  The patient was treated with ceftriaxone 2 g intravenously (IV) daily for two weeks with marked improvement already after three days. The patient was treated with ceftriaxone 2 g IV once a day for 14 days followed by TMP-SMX 800/160 mg twice a day. The patient was treated for 2 weeks with ceftriaxone (2 g IV once a day) followed by TMP-SMX 160 mg/800 mg, twice a day, planned for 1 year. WD has a dismal prognosis if left untreated. It is important to treat with antibiotics that penetrate the blood-brain barrier given that T. whipplei often is present in the CSF. WD without CNS involvement is initially treated with intravenous ceftriaxone 2 g once daily or meropenem (three doses of 1 g/day) for 2 weeks, followed by maintenance therapy with oral TMP-SMX 160 mg/800 mg twice a day for 1 year. The treatment for WD with endocarditis is penicillin G (2 million IU IV every 4 h) or ceftriaxone (2 g IV once daily) for 4 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. CNS involvement is treated with ceftriaxone (2 g IV once daily) or penicillin G (4 million IU IV every 4 h) for 2 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. Alternative therapies in case of intolerance are meropenem (1 g IV every 8 h) for 2 weeks followed by doxycycline (200 mg a day) in combination with hydroxychloroquine (600 mg a day) for 1 year. PCR for T. whipplei becomes negative soon after antibiotic therapy has commenced. Before stopping antibiotic therapy, upper endoscopy with duodenal biopsy and PCR testing is recommended to ensure complete remission. After discontinuation of antibiotic therapy, there is a 9-15% risk of T. whipplei to persist latently in the body for many years, mainly in patients with CNS involvement. The average interval between the end of antibiotic treatment and an ensuing relapse is 4.2 years but may occur even after 30 years. Therefore, annual check-ups are recommended for at least some years after the end of treatment.

• #83 Whipple’s disease: the great masquerader—a high level of suspicion is the key to diagnosis | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-01664-1

  The patient was treated with ceftriaxone 2 g intravenously (IV) daily for two weeks with marked improvement already after three days. The patient was treated with ceftriaxone 2 g IV once a day for 14 days followed by TMP-SMX 800/160 mg twice a day. The patient was treated for 2 weeks with ceftriaxone (2 g IV once a day) followed by TMP-SMX 160 mg/800 mg, twice a day, planned for 1 year. WD has a dismal prognosis if left untreated. It is important to treat with antibiotics that penetrate the blood-brain barrier given that T. whipplei often is present in the CSF. WD without CNS involvement is initially treated with intravenous ceftriaxone 2 g once daily or meropenem (three doses of 1 g/day) for 2 weeks, followed by maintenance therapy with oral TMP-SMX 160 mg/800 mg twice a day for 1 year. The treatment for WD with endocarditis is penicillin G (2 million IU IV every 4 h) or ceftriaxone (2 g IV once daily) for 4 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. CNS involvement is treated with ceftriaxone (2 g IV once daily) or penicillin G (4 million IU IV every 4 h) for 2 weeks, followed by TMP-SMX 160 mg/800 mg twice a day for 1 year. Alternative therapies in case of intolerance are meropenem (1 g IV every 8 h) for 2 weeks followed by doxycycline (200 mg a day) in combination with hydroxychloroquine (600 mg a day) for 1 year. PCR for T. whipplei becomes negative soon after antibiotic therapy has commenced. Before stopping antibiotic therapy, upper endoscopy with duodenal biopsy and PCR testing is recommended to ensure complete remission. After discontinuation of antibiotic therapy, there is a 9-15% risk of T. whipplei to persist latently in the body for many years, mainly in patients with CNS involvement. The average interval between the end of antibiotic treatment and an ensuing relapse is 4.2 years but may occur even after 30 years. Therefore, annual check-ups are recommended for at least some years after the end of treatment.

• #84 Whipple disease

  https://dermnetnz.org/topics/whipple-disease

  Infected individuals often need high doses of antibiotics in case the brain is infected by T. whipplei. An induction regime with intravenous ceftriaxone 2 g once daily is given for two weeks. […] Endocarditis and CNS involvement require a longer course of ceftriaxone or penicillin G. […] Longterm antibiotics such as trimethoprim+sulphamethoxazole should then be continued for up to one year to ensure complete clearance of T. whipplei. Followup upper GIT endoscopy is recommended before ceasing treatment.

• #85 Orphanet: Whipple disease

  https://www.orpha.net/en/disease/detail/3452

  According to the only available prospective randomized trial, treatment should consist in: 2 g Ceftriaxon daily intravenously for 14 days, followed by Cotrimoxazol twice daily for 12 months. […] In recurrent or resistant cerebral infection, contact with a TW specialist is recommended. Expert advice concerning treatment is indispensable in patients who have received immunosuppressive treatment prior to the diagnosis, including oral steroids, or when a clinical response to Ceftriaxone is not apparent within a few days. […] Lifelong clinical, non-invasive observation is advised in effectively treated patients, as late recurrences or de novo infections can occur.

• #86 Health Library

  https://www.limamemorial.org/m/health-library/HIE%20Multimedia/1/000209

  People with Whipple disease need to take long-term antibiotics to cure the infection that may include sites in the brain and central nervous system. An antibiotic called ceftriaxone is given through a vein (IV). It is followed by another antibiotic (such as trimethoprim-sulfamethoxazole) taken by mouth for up to 1 year. […] If symptoms come back during antibiotic use, the medicines may be changed. […] Your provider should closely follow your progress. Symptoms of the disease can return after you finish the treatments. People who remain malnourished will also need to take dietary supplements. […] If not treated, the condition is most often fatal. Treatment relieves symptoms and can cure the disease.

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