The Bottome Line: Whipple’s disease is characterized by two stages, a prodromal and a much later steady-state stage. The prodromal stage is marked by protean symptoms with chronic nonspecific findings, mainly arthralgia and arthritis. The steady-state stage is typified by weight loss, diarrhea or both. and on occasion there are other manifestations, since many organs can be involved. The average time between the prodromal and the steady-state stages is 6 years. 87% of patients are male.
Fenollar, Florence Whipple’s disease. The New England journal of medicine 2007 vol:356 iss:1 pg:55 -66
Whipple’s disease was invariably fatal before antibiotics. However, current recommendations are not based on therapeutic trials or the susceptibility of T. whipplei to various antimicrobial agents. Tetracycline has long been prescribed as a first-line treatment, however, the frequency of recurrence with this agent has been high, averaging28%. Therefore the standard antibiotic therapy currently favors antibiotics that are capable of crossing the blood–brain barrier, such as trimethoprim–sulfamethoxazole. However, lack of a clinical response has been reported with this strategy, and recurrence is also possible
Table 2. Demographic and Clinical Features of Classic Whipple’s Disease.