Side Effects of Whipples Disease

Categorized as a rare disease by the Office of Rare Diseases, a division of The National Institute of Health, Whipple's disease is an infectious pathology caused by a bacterium known as Tropheryma Whippei. Fewer than 200,000 individuals in the United States have been diagnosed with Whipple's. First identified by George Hoyt Whipple in 1907, the primary side effect of Whipple's is malabsorption, the inability to properly assimilate nutrients. The chronic, systemic condition can also affect the heart, lungs, eyes, joints and brain. Whipple's occurs more frequently in men--87 percent of those diagnosed with the disease are male, of whom the preponderance are Caucasian. Although Whipple's is curable with antibiotic therapy, left unattended the disease can give rise to serious complications, and in the absence of appropriate medical intervention, can be fatal.

Pathophysiology of Malabsorption

• The primary malady associated with Whipple's disease is malabsorption. This gastrointestinal disorder is characterized by fat deposits in the intestine mucosa and in lymph nodes. The physiological action of the gastrointestinal tract includes food digestion and the absorption of crucial nutrients such as carbohydrates, fats, proteins and homeostasis regulating micronutrients. The gastrointestinal systems of individuals suffering from Whipple's are incapable of performing these vital functions, leading to a number of unpleasant side effects.
  The most common side effect of malabsorption is persistent, watery, diarrhea. Steatorrhea, another side effect of malabsorption, results in pale, bulky, malodorous stools. These stools often float on the surface of the water because of their fat content, and individuals may also observe a greasy layer floating on the water.
  Another natural corollary to malabsorption is significant weight loss, since the body is not assimilating the nutrients necessary to maintain a reasonable weight. Although weight loss is quite often dramatic, some individuals are successful in hiding the condition by consuming large quantities of food-thus maintaining their normal weight.
  Flatulence and abdominal dissension are yet another side effect of malabsorption. Unabsorbed food substances lead to the fermentation of bacteria, a catalyst for the formation of the gases hydrogen and methane. This gaseous mixture induces flatulence. Excess gas in the gastrointestinal system can also cause abnormal abdominal dissension and severe cramping, a typical physiological side effect of redundant gas.
  Peripheral edema, the retention of excess liquid in the body, is often caused by malabsorption. Peripheral edema arises from the body's inability to metabolize protein. Severe protein depletion may in turn lead to the development of ascites, an abnormal accumulation of serous fluid in the spaces between tissues and organs.
  Anemia, or a compromised red blood cell count, can be a another problem for people suffering from malabsorbtion. This malady arises from the inability of the individual's gastrointestinal system to absorb Vitamin K, which can result in bleeding disorders.
  Metabolic defects of the bones due to Vitamin D deficiency can lead to a diagnosis of osteomalacia and/or osteopenia, severe bone deficiencies. Pathological fractures resulting from these two closely related pathologies have been observed in patient's with malabsorption.

Whipple's Disease as a Catalyst for Arthritis

• Despite the fact that intestinal distress is frequently cited as the primary malady associated with Whipple's disease, a growing body of evidence has indicated that a number of arthritic conditions precede gastrointestinal involvement. Dr. Xavir Puechal of Centre Hospitalier du Mans points out that joint manifestations antedate intestinal complaints in three-quarters of patients, and that a significant number of these patients present with no intestinal symptoms. The doctor argues that a number of clinical patterns independent of gastrointestinal symptoms suggest Whipple's disease. According to Dr. Puechal, "unexplained chronic seronegative oligoarthritis or polyarthritis affecting the large limb joints is the most common presentation" (of Whipple's disease). The ramifications of this hypothesis are important, since early diagnosis (before the disease wreaks havoc on the small intestine), can lead to early treatment and the avoidance of full-blown systemic complications.

Pleuritis and Whipple's Disease

• Pleuritis, more commonly referred to as pleursy, can be a side effect of Whipple's disease. Symptoms of Pleuritis include shortness of breath, cough, fever and chills, rapid, shallow breathing, sore throat and unexplained weight loss. Since Pleuritis can arise from a number of underlying conditions, it is only associated with Whipple's disease when observed with other pathologies consistent with that disease.

Cardiac Complication as a Symptom of Whipple's Disease

• Cardiac involvement is a common finding in individuals with Whipple's disease, and when presenting with other pathologies associated with Whipple's may be an important clinical sign. Intra-cardiac abnormalities include viral myocarditis, ishaemic cardiomyopathy, Fabry disease and congestive heart failure. Health care providers will order the appropriate tests if cardiac abnormalities are reported in conjunction with other symptoms of Whipple's disease.

Neurological Manifistations are Symptomatic of Whipple's Disease

• Neurological manifestations associated with Whipple's disease include involvement of the limbs, particularly the legs. Individuals may experience tingling, pain, unsteady gait and decreased weakness of the affected limb or limbs. Less common involvement has been observed in the arms, with patients complaining of significant weakness in those appendages. Complaints range from a reduced ability to grasp objects to shaky writing. Other neurological manifestations associated with Whipple's Disease include reduced cognitive abilities, confusion, behavioral changes and dementia. Neurological disorders resulting from Whipple's disease may also include muscle weakness, compromised visual acuity, facial numbness, tingling or pain in the limbs, (particularly the legs) and an unsteady gait.

Hyperpigmentation of the Skin and Persistant Fever May be Symptoms of Whipple's Disease

• Individuals diagnosed with Whipple's disease often experience hyper-pigmentation of the skin. Over-production of melanin causes darkened spots to appear on some individual's suffering from Whipple's. Since hyper-pigmentation is commonly observed in otherwise healthy patients, this skin discoloration is not associated with Whipple's disease in the absence of other symptoms of the disease. Persistent fever, another common symptom of Whipple's, can also arise from a plethora of pathologies, and should only be associated with Whipple's disease when other symptoms of the disease are observed.

Diagnosis and Treatment of Whipple's Disease

• Diagnosis of Whipple's disease is accomplished by performing an enteroscopy (viewing of the intestine with a lighted tube) and taking a small biopsy of the intestine for microscopic examination. Other diagnostic procedures include measuring sugar and albumin absorption and an analysis of fecal fat.
  Standard treatment of Whipple's includes intravenous antibiotic therapy followed by oral antibiotic therapy that may be administered for up to one year.
  Since Whipple's disease can and does recur, regular check-ups are necessary. Recurrence of the disease requires a repeat of the initial therapy, which can temporarily, or in some instances permanently cure the disease.
  Researchers at the Mayo Clinic also stress the importance of vitamin supplementation. Individuals who have been diagnosed with Whipple's disease should consult their health care provider as to what vitamin supplements to take.
  Because numerous pathologies can be associated with the symptoms of Whipple's disease, it is incumbent that individuals who suspect that they have Whipple's contact their health-care provider for a full-battery of diagnostic tests. Taken individually, the majority of these symptoms mimic numerous pathologies. It is therefore important not to attempt self-diagnosis based on medical literature. Self-diagnosis can cause individuals no small amount of confusion and unnecessary worry. An accurate diagnosis can alleviate the fears of those individuals who are not afflicted and garner the appropriate therapy for those who are. See your medical provider before jumping to erroneous conclusions.