DIAGNOSIS AND TREATMENT OF WHIPPLES-DISEASE

Whipple's disease is a rare systemic infectious disease, To date, it h as neither been possible to culture the bacillus Tropheryma whippelii, nor to infect other individuals with the pathogen, Today the diagnosi s is confirmed by means of polymerase chain reaction (PCR) technology. Typically, the material for the PCR analysis comes from the duodenum. The diagnosis can also be established in this way on the basis of oth er tissue, or the cerebrospinal fluid. Treatment should only be carrie d out with antibiotics which cross into the cerebrospinal fluid, since there can also be an unrecognised involvement of the CNS. At present, the favoured method of treatment is the daily parenteral administrati on of 1.2 million units of benzylpenicillin (penicillin G) and strepto mycin Ig for a period of 2 weeks. This is followed by treatment with c otrimoxazole (trimethoprim 160mg and sulfamethoxazole 800mg) twice dai ly for 1 to 2 years. The treatment should begin and end with a PCR ana lysis of cerebrospinal fluid, in order to definitively diagnose infect ion of the CNS with Whipple's disease and to document the disappearanc e of the bacillus from the CNS.