Whipple's disease revisited

Abstract

Whipple's disease has traditionally been considered to be a rare multisystem disorder dominated by malabsorption. The recent identification of the Whipple's disease bacillus has, using polymerase chain reaction based assays, fueled advances in the investigation, diagnosis, and management of this disease. This leader reviews the aetiology, clinical manifestations, investigation, and treatment of Whipple's disease in the light of this new information.

Figure 1 (A) Small bowel of a patient with Whipple's disease showing numerous periodic acid Schiff (PAS) positive macrophages in the lamina propria (magnification, x50). (B) Same biopsy at a higher magnification (x100) showing macrophages containing PAS positive granules.

Figure 2 Electron micrograph of small bowel tissue showing numerous extracellular bacilli (A), a phagosome containing bacilli (B) within a macrophage (M), and a neutrophil (N) (reproduced with permission^2a).

Figure 3 Immunological changes in Whipple's disease. **See Marth and colleagues¹²; *decreased IFN-γ production in vitro is overcome by adding IL-12 to the culture. IFN-γ, interferon γ; IL-12, interleukin 12; PMBC, peripheral blood mononuclear cells.

Figure 4 The appearance of the Whipple's bacillus on electron microscopy (magnification, x100 000), showing the characteristic trilamellar cell wall (reproduced with permission^35a).