Whipple’s disease is a rare bacterial infection primarily affecting the small intestine. It can cause internal sores, also called lesions, and the thickening of tissues. Villi, which are tiny fingerlike projections that line the small intestine, take on an abnormal, clublike appearance. The damaged intestinal lining fails to properly absorb nutrients, causing diarrhea and malnutrition.
Health experts are unsure how T. whipplei infects people. One theory is that some people are more vulnerable to Whipple’s disease, probably due to genetic factors that influence the body’s immune system. Also, the bacteria are more common in the environment—showing up in soil and sewage wastewater—than would be predicted based on the rareness of the disease. And while multiple cases of Whipple’s disease have occurred within the same family, no documentation exists of a person-to-person transmission.
Whipple’s disease is treated with long-term antibiotics that kill T. whipplei bacteria. Standard therapy for Whipple’s disease involves initial treatment with intravenous (IV) antibiotics for 2 weeks, followed by daily oral antibiotic treatment for 1 to 2 years. IV antibiotics are delivered through a needle inserted into a vein. IV antibiotics used to treat Whipple’s disease include ceftriaxone (Rocephin) and penicillin G (Pfizerpen) plus streptomycin.
Trimethoprim/sulfamethoxazole (Septra, Bactrim), a combination oral antibiotic that can enter the cerebrospinal fluid and brain, is commonly used to treat Whipple’s disease.
An alternative treatment for Whipple’s disease is a combination of doxycycline (Vibramycin) plus the antimalarial drug hydroxychloroquine (Plaquenil) taken for 12 to 18 months. Supporters of this approach recommend that people with neurologic Whipple’s disease also take long-term antibiotics that can enter the cerebrospinal fluid and brain, such as sulfamethoxazole.
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