WHIPPLES-DISEASE - STAGING AND MONITORING BY CYTOLOGY AND POLYMERASE CHAIN-REACTION ANALYSIS OF CEREBROSPINAL-FLUID

Background & Aims: Diagnostic procedures in Whipple's disease usually focus on the intestine, but symptomatic central nervous system involve ment is a major threat for patients. The aim of this study was to dete rmine the diagnostic value of cerebrospinal fluid (CSF) analysis. Meth ods: A total of 39 CSF samples and 2 brain biopsy specimens that were obtained from 24 patients with Whipple's disease at various intervals after diagnosis were examined. Five patients presented with neurologic al symptoms, 3 of them as relapses after therapy. Thirty-two CSF sampl es were examined by polymerase chain reaction for Tropheryma whippelii and 20 CSF samples by cytology. Brain biopsy specimens were examined histologically. Results: Positive results were obtained in 4 of 5 pati ents (80%) with neurological symptoms, in 7 of 10 patients (70%) witho ut neurological symptoms examined before therapy, and in 3 of 11 patie nts (27%) without neurological symptoms studied during or after therap y, Conversion from positive to negative was observed in 4 patients aft er antibiotic treatment, Conclusions: Testing of CSF in Whipple's dise ase yields a high rate of positive results, even in patients without n eurological symptoms, Examination of CSF is therefore potentially usef ul for initial staging and for monitoring of the efficiency of therapy .